Prevalence and treatment outcome of vulvovaginal candidiasis in pregnancy in a rural community in Enugu State, Nigeria

Abstract

Vulvovaginal candidiasis (VVC) is a common condition, and an estimated 75 % of all women experience an infection with candida yeast during their lifetime. The study involved 901 pregnant women presenting to a rural hospital for ante-natal care within a period of ten months. Those with abnormal vaginal discharge or pruritus were screened for VVC. Those with symptomatic diagnosis of VVC were recruited for the cohort study after appropriate counseling and obtaining informed consent. Culture of high vaginal swab (HVS) and urinalysis were performed. Treatment of significant cases involved the use of nystatin and clotrimazole vaginal inserts. A total of four treatment groups (n = 157) were employed. Groups 1 and 2 received differently daily normal doses of the agents for 7 days respectively. Groups 3 and 4 received twice daily dosing of both agents for 7 days. In each case, the symptomatic response and re-culture of the HVS were repeated after treatment. Pharmacoeconomics of the two drugs was evaluated for the ten months period of the study and the prevalence of the VVC finally deduced. The result showed that the pregnant women had non-complicated VVC. Treatment outcome was generally the same with both nystatin and clotrimazole which invariably showed the same efficacy. In the first two groups, 72 % of those treated with once daily dosing of nystatin had their symptoms resolved within one week and 75 % achieved symptom resolution with clotrimazole during the same period. Some 96 % and 97 % of repeat culture of HVS for those that received twice daily dosing of the nystatin and clotrimazole had negative cultures respectively. The pharmacoeconomics of both agents reveal a remarkable difference in that a week treatment (once daily dosing) of nystatin costs ninety-one naira (N91. 00) which is less than $1 and clotrimazole for the same duration costs one hundred and sixtyeight naira (N168.00) which is $1.5. Going by cost minimization since both agents have similar outcomes, nystatin will naturally be selected. In the face of scarce resources, the costs and outcome analyses are valuable in therapeutic decisions.