Species Distribution, Antifungal Susceptibility, and Factors Associated with Recurrence in Vulvovaginal Candidiasis

Objective: Vulvovaginal candidiasis (VVC) is a common condition in clinical practice, and the absence of standardized diagnostic criteria based solely on clinical findings remains a challenge. This study aimed to evaluate the distribution of Candida species, antifungal susceptibility patterns, recurrence rates, and clinical factors associated with recurrent disease. Methods: This retrospective study included 345 VVC episodes from 325 patients in whom Candida species were isolated from vaginal cultures. Demographic and clinical characteristics, identified Candida species, antifungal susceptibility test results, and recurrence patterns were analyzed. Associations with recurrent VVC were evaluated using univariable analyses and multivariable Firth penalized logistic regression. Results: Candida albicans was the most frequently isolated species, accounting for 85.2% (n = 294) of cases, followed by C. glabrata (9.6%; n = 33) and C. krusei (1.7%; n = 6). Fluconazole susceptibility patterns did not differ significantly between patients with ≥3 recurrent episodes and those with <3 recurrent episodes (p = 0.493). Similarly, no significant difference was observed for voriconazole susceptibility (p = 0.116). High in vitro susceptibility rates were observed for caspofungin, amphotericin B, and micafungin in both groups. Multivariable Firth logistic regression analysis demonstrated that smoking (OR = 3.83; 95% CI: 1.81–8.81; p < 0.001), intrauterine device use (OR = 16.77; 95% CI: 4.13–153.53; p < 0.001), and antibiotic use (OR = 7.81; 95% CI: 3.90–17.30; p < 0.001) were significantly associated with recurrence, whereas pregnancy was not significantly associated with recurrence (OR = 2.05; 95% CI: 0.78–5.66; p = 0.147).