Article Text
PDF
Statistics from Altmetric.com
Rates of fluconazole-resistant Candida albicans and non-C. albicans yeasts are increasing in the UK. In Leeds, between 2018–2019 and 2020–2021, the percentage of non-C. albicans yeasts rose from 6.0% to 12.6% and fluconazole dose-dependent/resistant isolates increased from 3.5% to 9.6%.1 Prolonged courses of self-purchased antifungals,2 and presumptive diagnoses with inappropriate empirical treatment,1 have been associated with fluconazole resistance. Clinical symptoms and signs of vulvovaginal candidiasis (VVC) are non-specific, and empirical antifungal prescribing results in over 50% of antifungals being ineffective or unnecessary.3
Most people presenting to sexual health clinics with symptoms suggestive of VVC have already self-medicated or been prescribed treatment within primary care without resolution of their symptoms, so an accurate diagnosis needs to be made, rather than giving further empirical treatment, as this helps reduce resistance.
When are in-clinic microscopy of a vaginal smear and fungal culture, species and susceptibilities appropriate
Microscopy is a standard test for the diagnosis of several genital infections in sexual health clinics, so a Gram-stained vaginal smear and/or a wet-prep slide is a cheap point-of-care test for the diagnosis of VVC and should be performed on all women with vaginal discharge. However, the sensitivity of microscopy is only about 50%. Also, microscopy identifying pseudohyphae confirms C. albicans infection, and microscopy identifying only multiple blastospores suggests non-C. albicans yeasts infection, but not their azole susceptibilities.
Thus, fungal culture, species and susceptibilities are recommended when symptoms/signs suggest candidiasis and the patient reports no response to azoles in the following circumstances:
If the microscopy is negative, as this excludes the inappropriate diagnosis of recurrent vulvovaginal …
Footnotes
Handling editor Daniel Richardson
Contributors JW is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.