Objectives. Chronic recurrent vulvovaginal candidosis (CRVC) is a major clinical problem. Results of treatment of CRVC not always are satisfactory. Knowledge of etiology of CRVC is issential for adequate antimycotic therapy. Aim of the study – to examine etiology of CRVC in 2003-2016 in Saint-Petersburg, Russia and to study the peculiarities of CRVC caused by C. albicans with reduced in vitro fluconazole sensitivity.

Methods. In prospective study in 2003-2016 we included 1390 immunocompetent HIV-negative CRVC patients (age 15-70, median – 32,2). Sobel et al 2004 diagnostic criteria of CRVC were used. Determination of Candida species was made with AUXACOLOR 2 (BioRad, USA) and MALDI-TOF MS. CLSI M44-A disk-diffusion method was used for in vitro sensitivity testing to fluconazole. Bacterial vaginosis was diagnosed based on Amsel’s criteria and on detection of Gardnerella vaginalis and Atopobium vaginae using PCR method. RBV diagnosis was established at the ≥4 frequency of the episodes per year. Statistical data manipulation was carried out by of methods of parametric and nonparametric statistics.

Results. In 2003-2006 yy. we included 251 CRVC patients (age 15-70, median – 29); 2007-2012 – 706 (age 17-57, median – 27,6); 2012-2016 – 433 (age 17-56, median – 31,3). In 2007-2016 increased the percentage of Candida albicans among agents of CRVC: 2003-2006 – 83%, 2007-2012 – 89%, 2012-2016 – 92% (p<0,05). At the same time decreased the frequency of C. glabrata (5,2% vs 2,6% vs 2,8%) and C. krusei (4,8% vs 1,3% vs 1,6%).

In 2012-2016 was detected reduction of C. albicans susceptibility to fluconazole in vitro: 91% vs 98,5% vs 99,1%, p<0,05).

In 2003-2016 among 1390 CRVC patients were found 55 patients with CRVC caused by C. albicans with reduced in vitro fluconazole sensitivity (the main group). The control group consisted of 270 patients with CRVC caused by C. albicans sensitive to fluconazole. Maintenance fluconazole therapy during 6 months for prevention of CRVC recurrence in the main group received 38% patients vs 31% in control group, p>0,05). RBV was detected in 78% patients of the main group vs. 19% in control group, p<0,01.

Conclusions

1. In 2012-2016 the frequency of C. albicans grew from 83% to 92% (p<0,05), and reduction of C. albicans sensitivity to fluconazole in vitro from 99% to 91% (p<0,05) was detected.

2. No influence of maintenance therapy with fluconazole during 6 months on resistance of C. albicans to this medication in vitro has been detected.

3. The recurrent bacterial vaginosis was more often detected in cases of candidosis caused by C. albicans with a reduced sensitivity to fluconazole (78% vs. 18%, p<0,01)..

CHANGING ETIOLOGY OF CHRONIC RECURRENT VULVOVAGINAL CANDIDOSIS IN 2003-2016 IN SAINT-PETERSBURG, RUSSIA