Prevalence, Risk Factors, and Co-Occurrence of Candida Species and Bacterial Vaginosis Among Women in the Eastern Cape, South Africa: A Cross-Sectional Study

The cervicovaginal microflora plays a vital role in maintaining vaginal health, and disturbances can predispose women to opportunistic infections and sexually transmitted infections (STIs). This study examined the prevalence and associated factors of Candida species, bacterial vaginosis (BV), and their co-occurrence among women in the Eastern Cape province of South Africa. A cross-sectional design was employed, enrolling 325 women aged 18–60 years from a health facility in the Eastern Cape, South Africa. Candida species were identified in cervical specimens using a Seegene Allplex™ Candidiasis Assay. BV status and BV-associated bacteria were identified via Seegene Allplex™ Bacterial Vaginosis Plus assays. Overall, 64.51% of participants were HIV-positive, 15.74% tested positive for Candida species, 52.85% tested positive for BV, and 7.10% were positive for BV–Candida species co-occurrence. The highest prevalence of Candida species (23.60%; R2 = 0.913; p = 0.015), BV (85.39%; R2 = 0.931; p = 0.003), and Candida–BV co-occurrence (7.10%; R2 = 0.903, p = 0.041) was observed in the 18–29 age group and declined significantly with age. Women with four to six lifetime sexual partners had higher odds of testing positive for Candida species (AOR: 2.42, 95% CI: 1.21–4.82, p = 0.012). Currently presenting with STI symptoms (AOR: 4.66; 95% CI: 1.29–16.87; p = 0.019), increased (four to six) lifetime sexual partners (AOR: 5.58; 95% CI: 1.16–26.82; p = 0.032), and being HPV-positive (AOR: 7.28; 95% CI: 1.17–45.26; p = 0.033) were independent predictors of Candida–BV co-occurrences. In this current study, having multiple lifetime sexual partners was independently associated with Candida species positivity, while current STI symptoms, HPV infection, and having four to six lifetime sexual partners significantly increased the likelihood of Candida–BV co-occurrence, highlighting the role of sexual behaviour in the vaginal microbial profile. This underscores the need for continued surveillance and longitudinal investigation. Longitudinal studies to further investigate these associations are warranted.