| Chapter 1 Susceptible factors of vulvovaginal candidiasisObjective:To explore the susceptibility factors of vulvovaginal candidiasis(VVC)at the age of childbearing for women in Kunming,and to provide effectively a scientific basis for the development of preventive measures.Method:A questionnaire survey was conducted among the age of women childbearing was strictly incorporated with the inclusion and exclusion criteria in the gynecology and obstetrics clinic of the Second Affiliated Hospital of Kunming Medical University from December 1st,2017 to May 31st,2018.The patients were divided into WC group and VVC group in pregnancy,while women who received routine gynecology,obstetric examination and normal vaginal secretion examination were used as a control group,was performed with one-factor analysis by rank sum test and x2 test,even the influencing factors of meaning chosen from one-factor was analyzed by multivariate unconditional logistic regression analysis.Results:(1)The analysis of multivariate logistic regression in VVC group says the number of abortions(OR=3.84,95%CI=1.68-8.75,P=0.000),distressing(OR=12.36,95%CI=1.23-124.71,P=0.03),frequent sexual life(OR=31.72,95%CI=2.55-93.89,P=0.01),and menstrual sex(OR=22.83,95%CI=1.39-74.13,P=0.03)are VVC risk factors;even the usage of condoms(OR=0.06,95%CI=0.01-0.38,P=0.00),daily cleansing of the genitals in non-menstrual(OR=0.15,95%CI=0.03-0.84,P=0.03),wiping front to back with toilet paper(OR=0.04,95%CI=0.01-0.33,P=0.00),and regular exercise(OR=0.06,95%CI=0.01-0.68,P=0.02)are protective factors of VVC.(2)The analysis of multivariate logistic regression in WC group in pregnancy shows pregnancy(OR=1.85,95%CI=1.15-2.98,P=0.01),frequent cold(OR=5.39,95%CI=1.25-23.22,P=0.02),the age of first sexual life(<18 years)(OR=12.03,95%CI=1.37-105.44,P=0.02),pregnancy period are(OR=2.17,95%CI=1.10-4.25,P=0.02)risk factors of VVC.The usage of condoms(OR=0.26,95%CI=0.09-0.79,P=0.02),cleaning the genitals every day during pregnancy(OR=0.19,95%CI=0.07-0.50,P=0.00),regular exercise(OR=0.34,95%CI=0.13-0.91,P=0.03)are protective factors of WC.The rank-sum test is used to analyze the difference between the first sexual life age(r=0.260,P=0.000)and VVC.The smaller age of the initial sexual life,VVC the more likely happened.Conclusion:VVC has a variety of risk factors,pregnancy,abortion frequency,pregnancy period,first sexual life,frequent cold,stress,frequent sexual life,and menstrual sex are risk factors of VVC;The use of condoms,daily cleaning of the genitals during non-menstrual periods,toilet paper wipes from the back to the rear,and regular exercise may be protective factors of VVC.Chapter ? Analysis of genotyping and drug resistance of pathogenic bacteria in vulvovaginal candidiasisObjective:To study the genotypes of pathogenic bacteria of vulvovaginal candidiasis(VVC),and to analyze the difference of dominant genotypes of pathogenic bacteria in different age groups,nationality,different gestational periods,gestation and non-pregnancy,at the same time the relationship between drug resistance and genotype was studied.Method:To collect vaginal secretions from patients with VVC diagnosed in the Department of Gynecology and Obstetrics,Second Affiliated Hospital of Kunming Medical University from December 1,2017 to January 31,2018.125 strains of Candida albicans and 51 strains of Candida glabrata were collected by culture,isolation and identification.The Candida albicans and Candida glabrata were genotyped by CAI and RPM2,MT1 and ERG3 microsatellite loci and ATB-Fungus3 was used for drug sensitivity test.Results:(1)The detection rate of Candida glabrata in inchoate pregnancy is higher than that in the middle and late stage(8 strains,50.0%)and the detection rate ofCandida alb cans in the middle pregnancy is 84.6%and the detection rate in the late pregnancy is 88.9%.There are significant differences in the distribution of Candida albicans and Candida glabrata between different stages of pregnancy(P=0.011).(2)There are 48 genotypes of Candida albicans,including 3 dominant genotypes:30-45,15-18,32-46;17 species of genotypes are distinguished by Candida glabrata and they mainly has 3 kinds of genotypes:128:241:198,128:240:198,140:241:198.(2)The main genotypes of Candida albicans in non-pregnancy VVC infection are different from the main genotypes of VVC infection during pregnancy(P=0.015);There are some differences between the main genotypes of non-pregnancy VVC infection with Candida glabrata and VVC infection during pregnancy in major genotypes(P<0.001).(3)The sensitivity rate of Candida albicans to 5-FC is 96.0%,and the resistance rates to FLU and VOC are 32.8%and 36.0%.The wild type strain of Candida albicans in AMB is 100%;the sensitivity rate of Candida glabrata to 5-FC is 100.0%,and the resistance rate to FLU is 3,9%.The wild type strain of Candida glabrata in AMB is 100%;the wild type strain in ITC is 99.2%,and the non-wild type strain is 0.8%;the wild type strain and the non-wild type strain in VOC are 68.6%and 31.4%.(4)The resistance rates of different genotypes of Candida albicans to FLU are significantly different,and there is also statistical significance when the concentration of ITC is?1mg/L(P<0.05).The different genotypes of Candida albicans are related to FLU,ITC and VOC.There is no statistically significant difference in drug resistance rates.Conclusion:We not only found the unique genotype distribution of VVC in Kunming,but also find that the different genotypes of different strains had statistical significance in the distribution of VVC between pregnancy and non-pregnancy.The main genotype of Candida albicans infection in early pregnancy is 15-18,and the main genotype of infection in late pregnancy is 32-46;The main genotype of Candida glabrata infection in early and middle pregnancy was 128:240:198,and the main genotype of infection in late pregnancy was 128:241:198,even the relationship between different genotype strains and drug resistance is found. |
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