Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa.
Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa.
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DOI：
10.4103/2141-9248.133470
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发表时间：
2014-05
影响因子：
--
通讯作者：
Moodley P
中科院分区：
文献类型：
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作者：
Apalata T;Longo-Mbenza B;Sturm A;Carr W;Moodley P
症状性外阴阴道念珠菌病（VVC）是最常见的问题之一，导致妇女在初级保健机构寻求咨询。本研究的目的是描述一些假设的因素和症状性VVC的存在之间的关联。进行了一项分析性横断面研究。2011年6月至2011年12月期间，在南非夸祖鲁-纳塔尔的一家初级卫生诊所Umlazi D诊所，共招募了90名诊断为症状性VVC的女性和108名无症状性VVC的女性。通过阴道拭子的革兰氏染色和微生物培养确定确认的症状性VVC。对于人类免疫缺陷病毒（HIV）感染的女性，通过实时聚合酶链反应（BioMerieux，里昂，法国）测定血浆和生殖器液中的HIV核糖核酸载量。从患者的病历中获得CD 4计数。使用社会科学统计软件包（SPSS）21.0版（SPSS Inc.;芝加哥，IL，美国）。采用多元logistic回归模型排除单变量混杂因素。所有检验均为双侧检验，P < 0.05视为显著。90%（81/90）有症状的VVC患者主诉外阴瘙痒、疼痛和阴道分泌物，75.9%（82/108）无症状的VVC患者主诉外阴瘙痒、疼痛和阴道分泌物（P < 0.01）。妊娠与症状性VVC独立相关（P < 0.01），后者与Nugent评分呈负相关（P < 0.01）。与HIV阴性女性相比，HIV相关免疫功能低下（CD 4计数< 200个细胞/mm 3，P < 0.001）女性的症状性VVC的几率增加，其生殖道中的HIV显著脱落（P = 0.04），血浆HIV载量> 1000拷贝/mL（P < 0.001）。在HIV感染妇女中，使用高效抗逆转录病毒治疗与症状性VVC的存在呈显著负相关（P < 0.01）。虽然症状性VVC不被归类为获得性免疫缺陷综合征相关疾病，但HIV相关免疫功能低下的女性，特别是那些未接受过抗逆转录病毒治疗的女性，可能会发生症状性VVC。
Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities. The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC. An analytical cross-sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu-Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)-infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real-time-polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients’ medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two-sided and a P < 0.05 was considered to be significant. A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01). Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent's scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV-associated immunocompromise (CD4 counts < 200 cells/mm3, P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti-retroviral therapy and the presence of symptomatic VVC in HIV-infected women (P < 0.01). Although symptomatic VVC is not classified as acquired immunodeficiency syndrome-related condition, HIV-related immune compromised women and particularly those who are anti-retroviral therapy-naïve are likely to develop symptomatic VVC.