Vulvovaginal candidiasis: symptomatology, risk factors and concomitant anal colonization

PURPOSE: to analyze patients with vulvovaginal candidiasis with respect to risk factors, symptomatology and results of anal culture, to identify the frequency of species of Candida albicans and non-C. albicans, and to correlate anal and vaginal colonization. METHODS: a total of 99 patients were included with suspected vulvovaginal candidiasis, from Natal, Brazil, between May 2003 and May 2005, totalling 294 collections. The clinical material, obtained by vaginal and anal swabs, was seeded on CHROMagar Candida (R). The yeasts were identified using the classic method, in addition to the growth test at 42 degrees and 45 degrees C and the Hypertonic Saboraud broth test. Symptomatology, risk factors and anal colonization were assessed according to positive or negative culture for Candida spp. The cultures positive for C. albicans at the two sites were compared with other results encountered. Yates chi(2) test and Fisher's exact test were used for statistical analysis. RESULTS: the most frequent was C. albicans in 69% of the cases. Wearing tight and/or synthetic underclothing, the presence of allergic diseases, the occurrence of itching, leukorrhea and hyperemia showed a significant association with positive culture for Candida spp in the vagina. The chance of a patient with positive anal colonization to present with concomitant positive vaginal colonization was 2.8 and 4.9 times greater for Candida spp and C. albicans, respectively. The risk of a patient with anal culture positive for C. albicans to present with positive vaginal colonization was 3.7 times greater when compared to non-C. albicans species. CONCLUSIONS: the most common species was C. albicans, and a relevant association between vaginal cultures positive for Candida spp and the use of tight and/or synthetic underclothing, allergic diseases, the occurrence of pruritus, leukorrhea and erythema was observed (p<0.05). Positive anal colonization concomitant with vaginal colonization was significant, suggesting possible vaginal contamination from the anus.