Proteinase detection, DNA typing and antimycotic susceptibility of Candida isolates from Colombian women with vulvovaginal candidiasis.

Forty non-pregnant Colombian women (ages 18-45) with vulvovaginal candidiasis diagnosis (VVC) were enrolled in a blinded study to compare the efficacy of Itraconazole (ITRA) 400 mg vs. Fluconazole (FLU) 150 mg. Sexual partners received similar therapy. Proteinase detection by the Staib method and minimal inhibitory concentration (MIC) for FLU and ITRA by Etest method were performed in all Candida isolates. Patients were followed one year to determine clinical evolution and recurrence of VVC (RVVC). The strain identity of the RVVC isolates was determined by contour-clamped homogeneous electric field (CHEF) gel electrophoresis karyotyping and restriction fragment length polymorphism (RFLP). Thirty patients (75%) had one or two episodes of VVC/year, 83% of these were due to Candida albicans, while ten patients (25%) developed RVVC (three or more episodes/year); seven of them were treated with FLU. Non-C. albicans Candida species were detected in five of 30 (17%) of the patients with VVC and in seven of ten (70%) patients with RVVC (p=0.003). Isolates from nineteen patients were proteinase positive. Proteinase production and type of treatment were not related to recurrence of VVC (p>0.05). DNA typing revealed that in this population RVVC might be due to the same strain, substrain shuffling or different strains and species.