Policy change linked to rise in treatment-resistant vaginal thrush-+
· News-MedicalWhile the exact reasons for these trends aren't yet clear, they follow a shift in clinical practice, with the aim of reducing laboratory workload, say the researchers. Family doctors in primary care are now encouraged to treat vaginal thrush empirically-;on signs and symptoms alone, rather than on confirmatory lab test results.
Resistance or lack of sensitivity to the mainstay of antifungal treatment (azoles) in Candida specimens from patients with a vaginal infection has been reported in other countries. This has also been noted in the UK, but only in specialist clinics, explain the researchers.
To obtain a more evidence based picture of resistance levels and analyse wider trends, the researchers reviewed the culture results of 5461 vaginal swabs previously taken from women with suspected complicated or recurrent yeast infection in Leeds, northern England, between April 2018 and March 2021.
And the overall prevalence of fluconazole resistance increased from just under 1% in 2018–19, to 1.5% in 2019–20, and to 3% in 2020–21-;a more than fourfold increase over the 3 years.
In 2020–21, none of the yeasts from patients sampled at specialist sexual health clinics responded to fluconazole. No cases of overall resistance or reduced susceptibility were seen in hospital patients in 2018–19 and 2019–20, but some cases were seen in 2020–21.
"This increase in [non-albicans] species is of clinical concern as some have intrinsic reduced susceptibility to fluconazole," they highlight.
"Since 2013, UK primary care guidance (https://cks.nice.org.uk/topics/vaginal-discharge/) has recommended a clinical diagnosis of acute [vulvovaginal candidiasis] be made based on the typical signs and symptoms…(with testing for vaginal pH if available), followed by empirical treatment with single dose oral fluconazole or clotrimazole pessary," explain the researchers.
"However, there is considerable evidence that [vulvovaginal candidiasis] is over diagnosed clinically by both clinicians and patients, so empirical treatment leads to inappropriate azole use," they add.
"A clinical diagnosis, followed by empirical treatment, has been recommended instead. Consequently, we believe this policy of encouraging empirical vaginitis treatment based on non-specific symptoms and signs needs revisiting."
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