The Prevalence of Vaginal Candida Colonization among Female Students in Bingham University

Aim: To determine the prevalence of vaginal Candida colonization among female students in Bingham University. Place and Duration of Study: This study was carried out in Bingham University, Auta balefi, Karu LGA, Nasarawa State between the months of March and July 2015. Research Hypothesis: The prevalence of Candida albicans is not significantly high in the high vagina swab of most females; therefore the null hypothesis will be that the prevalence of Candida albicans is highly significant in the high vagina swab of most females. Materials and Methods: High vagina swab of ninety six female students was collected and screened for the presence of Candida albicans. Questionnaires were issued to obtain demographic information. Inoculation was carried out on Sabourad Dextrose Agar, incubated for 48 hours at 37oC and positive growth was checked for on Corn Meal Agar after 72 hours of incubation at 37oC, positive growth was identified further by the use of the germ tube test using human serum and incubated between 2 to 4 hours. Original Research Article Maikenti et al.; BMRJ, 12(2): 1-7, 2016; Article no.BMRJ.22843 2 Results : Ninety six females were screened and 25(26.0%) was infected. This reveals that the prevalence of Candida albicans was highly significant at X =1.758, df = 2 at .05, P =. 05. The highest prevalence was recorded among female students within the age group of 16-20 years, (15.6%). Conclusion: This study reveals that candidiasis caused by C. albicans is a major health challenge among female students. Therefore the practice of good personal hygiene is highly recommended in order to prevent the spread of the infection.


INTRODUCTION
Candida albicans is an opportunistic fungal pathogen that is responsible for candidiasis in the human hosts [1]. Among microbial diseases, fungal diseases are emerging rapidly, especially in the last twenty five years. Candida although a commensal fungi is the most prevalent fungal pathogen causing both mucosal and systemic infections [2,3]. Candida species are reported as common cause of vaginal discharge worldwide [4,5]. Candida albicans occurs as a harmless commensal in the gastrointestinal and genitourinary tracts in about 70% of humans and 75% of women will suffer from candida or vaginal yeast infection at least once in their lives. Virtually 40 to 50 percent of women will also experience multiple infection [6]. Candida species are part of the normal flora of the lower genital tract in 20-50% of healthy asymptomatic women [7,8] which causes diverse disorders that may include thrush, Candida enteritis, urinary tract candidiasis, mucocutaneous candidiasis and invasive candidiasis [9]. Candida may cause urinary tract infections which accounts 10-15% of the total reported urinary tract infections [10]. It may also cause male infertility [11] vulvovaginal candidiasis [12,13], oropharyngeal candidiasis, systemic candidiasis and cutaneous candidiasis [14]. Carrier rates are higher in women treated with broad spectrum antibiotics [15] pregnant women, diabetic women [16,17] and those with HIV/AIDS [18,19].
The commonest sign of infection is vaginal discharge which could be generally profuse, white, yellow or green, thick, and odorless. Several factors can be associated with increased rate of vaginal colonization by Candida albicans, these include pregnancy, use of high estrogen content and oral contraceptives [20], uncontrolled diabetes mellitus [21], poor dietary habits, poor personal hygiene and prolonged use of broad spectrum antibiotics [22] which kill the good and beneficial bacteria, allowing yeast overgrowth.
Candida albicans and other candida species have been isolated from several clinical specimens in different parts of Nigeria [23]. In a study conducted by Ojiyi et al. 2012, a prevalence rate of 14.75% was recorded among sexually active women in Maiduguri, Nigeria [24]. Throughout the world, prevalence rates for Candidiasis and Candidemia are similar [25], and this has led to the general consensus that Candida albicans is the most commonly isolated species however; there has been a growing trend of recovery of non-albicans species.

Study Area
This study was carried out in Bingham university Auta-balefi Karu, Nasarawa State. This community is situated in the middle belt of Nigeria at longitude 8º32'N 8º18'E and Latitude 8.533ºN 8.300ºE and is characterized by a tropical sub-humid climate with two distinct seasons; wet and dry seasons. Monthly temperature ranges from 20ºC to 34ºC and annual rainfall ranging from 1100 mm to about 2000 m [26]. It occupies a land mass of over 200 square meters, found at 23 kilometers away from Abuja [27].

Sample Collection
Ninety-six high vagina swab collected was obtained from female students between the ages of 16-30 years. The study was conducted in compliance with Bingham University's ethical committee approval.
Sterile swab sticks were labeled and accompanied with a questionnaire and was randomly given to any interested female students in the hostel. High vaginal swabs were obtained from apparently healthy students who indicated their interest in the research as there was no criterion for inclusion or exclusion in the study. A brief enlightenment on the purpose, importance of participating and how to collect the right sample from the vagina were properly explained.

Culture
The high vagina swab collected was used to inoculate on Sabouraud Dextrose Agar (SDA) and incubated aerobically at 37ºC for 48 hours and Candida species were checked for on Corn Meal Agar (CMA) plates and incubated at 37ºC for 48 hours. First, an inoculum pool was made with the swab specimen then; a sterile wire loop was used to spread the inoculum by streaking in quadrant to obtain discrete colonies. Incubation was at 37ºC for 48 hours under aerobic conditions. Colonies which appeared white to cream in colour with a smooth border and a pasty and moist consistency were observed.

Germ Tube Test
Germ tube experiment was used as a rapid tool for identification of Candida albicans. Using a sterile loop, a small portion of a pure colony of Candida albicans was harvested and inoculated in to sterile test tubes containing 0.5 ml of human serum. The resulting suspension was incubated aerobically at 37ºC for 3 hours. A drop of the yeast-serum suspension was placed on a clean microscope slide with 1 drop of cotton blue lactophenol stain and covered with a cover slip and examined microscopically, using the x10 and x40 objective lenses of an olympus microscope. The appearance of small, sprouting tube-like outgrowths or filaments projecting from the cell surface confirmed production of germ tubes [28].

Statistical Analysis
The statistical sampling method of the results were analyzed using, simple percentage and the relationship between risk factors and microbiological results was compared and using SPSS version 20 on windows 7 packages which was relevant to Chi-square statistics. The significant prevalence of Candida albicans was determined by X 2 at P=.05.   Table 2 shows the prevalence of Candida albicans in relation to age of the students. The total prevalence rate based on age was 26%. Students between the age of 16-20 years had the highest prevalence rate of (15.6%) while those between the ages of 21-25 years had a prevalence rate of (10.4%). Table 3 shows the prevalence of Candida albicans in relation to antibiotic chemotherapy, trend of diabetes, vagina discharge/discomfort, the use soap to wash their genital area and the use of the hostel toilet to urinate. Table 4 shows the prevalence of Candida albicans in relation to type of underwear and age distribution. 14(56%) make use of cotton under wears; those that make use of tight under wears had a prevalence of 16(64%). Table 5 shows the prevalence of Candida albicans in relation to method of vaginal clean up and age distribution. The use of baby wipe by the female students to clean their genital area had the highest prevalence of 5(20%) while the use of water, tissue and water had a total prevalence of 4(16%).

DISSCUSSION
The overall prevalence of Candida albicans in this research reveals that out of a total of 96(100%) females examined, 25(26.0%) were found to be positive and 71(74.0%) were negative, which shows that the prevalence rate of Candida albicans among the subjects was significantly high at X 2 =1.758, df =2 at P=.05, (P=5.991). Those within the age group of 16-20years had the highest record of the infection 15(15.6%) while those within the age group 21-25 years had a prevalence rate of 10(10.4%). The Statistical analysis (Chi-square) shows a significant difference within the age group of 21-26 at P = .05.These findings revealed that the infections was almost uniformly distributed in the subjected age groups indicating that Candida albicans is more frequent within the age range of 16-25 years and those within this age range were found to be sexually active. This can be attributed to several factors such as lack of personal hygiene and wearing tight under wears. This could also be due to the fact that as girls mature, hormonal changes takes place thereby making them more vulnerable to Candida albicans infection. This can also be due to the high oestrogen content of the vaginal epithelia [29].
The prevalence rate of 25(26.0%) obtained from this study was lower when compared to the findings of [30,31] who reported a prevalence rate of 28.0% and 52.5% respectively. The prevalence rate of 77.0% reported by [32] among HIV-infected women in Sagamu, Ogun state, Nigeria and the 70.0% reported by [33] among females of reproductive age in Kano, Nigeria was higher than the prevalence rate recorded in this study.
This study also reveals that out of 25(26.0%) who tested positive for Candida albicans infections, 8(32%) responded to the use of antibiotic chemotherapy such as; Flucomol-50 mg, Mycoten, Ketoconazole, Folic acid, Palutrine, Tegretol, Amatem, Nemoxil (Amoxicillin Tryhidrate), while 17(68%) with the infection were not on any antibiotic therapy. In a study carried out by Cutler [34], candida infections was common in patients with long history of antibiotic usage or indiscriminate administration of broad spectrum antibiotics which has a side effect of destroying resident friendly flora in the bowel, thus resulting in an imbalance of the micro flora occurring in the bowel.  In this study, the prevalence rate of Candida albicans in relation to vaginal discharge or discomfort, shows that 6(24%) had vagina discomfort/ vaginal discharge and this agrees with the findings of [35]. Vagina discharge or discomfort is one of the most frequent gynecological problems encountered in females especially during their reproductive stage as an alteration in the normal vagina flora can cause the over growth of bacteria that creates vaginal discharge and this is usually common among sexually active women. This study also reveals that females that who use cotton under wears had the highest frequency

LIMITATION OF THE STUDY
The study was limited to students of the University and the laboratory tests carried out. However, due to financial constraint, the laboratory tests were not extended to molecular techniques. The refusal of some female students to participate in the study due to personal reasons posed a challenge to this work.

CONCLUSION
This study indicates that the prevalence of vaginal candida colonization among female students is highly significant. Predisposing factors such as the use of tight under wears, indiscriminate administration of antibiotics should be avoided. The practice of good personal hygiene will go a long way to prevent and reduce the spread of the infection.