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Infectious Diseases in Obstetrics and Gynecology
Volume 2007, Article ID 82412, 5 pages
Clinical Study

Species Distribution and Susceptibility to Azoles of Vaginal Yeasts Isolated Prostitutes

1Centro de Investigaciones en Enfermedades Tropicales (CIET), Facultad de Microbiologia, Universidad de Costa Rica, San José 2060, Costa Rica
2Departamento de Control de SIDA y Enfermedades de Transmisión Sexual, Caja Costarricense de Seguro Social, San José 1000, Costa Rica
3Karolinska Institutet, Department of Laboratory Medicine F72, Karolinska University Hospital, Stockholm 141 86, Sweden

Received 23 April 2007; Accepted 29 May 2007

Copyright © 2007 Norma T. Gross et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We investigated the use of miconazole among female prostitutes in Costa Rica as well as the distribution of vaginal yeasts and the susceptibility pattern to azoles of strains obtained from this population. Our intention was to relate a frequent use of miconazole to occurrence of vaginal yeasts resistant to azoles. Methods. Vaginal samples were taken from 277 patients that have previously used azoles. Vaginal swabs were obtained for direct microscopy and culture. Yeast isolates were identified by germ tube test and assimilation pattern. Susceptibility testing was determined using a tablet diffusion method. Results. The number of clinical Candida isolates (one from each patient) was 57 (20.6%). C. albicans was the predominant species (70%), followed by C. parapsilosis (12%), C. tropicalis (5.3%), C. glabrata and C. famata (3.5% each), C. krusei, C. inconspicua and C. guilliermondii (1.7% each). The majority of vaginal Candida isolates were susceptible to ketoconazole (91%), fluconazole (96.5%), and itraconazole (98%). A lower susceptibility of some isolates to miconazole (63%) was observed as compared to the other azoles tested. Moreover, the strains, nonsusceptible to miconazole, were more often obtained from patients that have used this antifungal at least four times within the last year before taking the samples as compared to those with three or less treatments (P<.01). Conclusion. An indiscriminate use of miconazole, such as that observed among female prostitutes in Costa Rica, results in a reduced susceptibility of vaginal yeasts to miconazole but not to other azoles.