A study of Antifungal Drug Resistance in vaginas of women who came for Sexually Transmitted Infections Screening services at STIs 10 Center, Chiang Mai
Keywords:
การดื้อยารักษาเชื้อรา, โรคติดต่อทางเพศสัมพันธ์Abstract
Vulvovaginal Candidiasis (VVC) is the most frequent Sexually Transmitted Infection (STI). Seventy- five percent of women in the U.S.A will have VVC once in their lifetime. In the Sexually Transmitted Infections Center 10 ( STIs 10) in Chiangmai, VVC diagnosis is around 20 -30 % of overall STIs incidence each year. VVC is the most frequently found STI in STI screening in prostitutes and housewife clients. Effective treatment of VVC can prevent HIV spreading because often Vulvovaginitis will increase HIV spreading if a sex partner has HIV and did not use a condom during vaginal sex. Now, STIs 10 Center has questions about the effectiveness of antifungal drugs that have been used widely in Thailand for more than 10 years, by recommendation of STIs standard guidelines, because STIs 10 center has frequent cases of repeat VVC. Some kinds of drugs are very easy to buy and use, such as Clotrimazole vaginal suppository, and this may produce drug resistance. This study shows that fungus in the vagina of housewives and prostitutes is the species Candida albicans 68.6% and 77.2% respectively. When comparing MICs of each fungal isolate to the standard resistance break point of each antifungal drug of NCCLS (M27-A), we found that 261 cases of housewives had 84 fungal isolates of every species. 65 isolates (77.38%) were resistant to Clotrimazole, 68 isolates (80.95 %) were resistant to Itraconazole, 14 isolates (16.66 %) were resistant to Fluconazole, and 7 isolates (8.33 %) were resistant to Ketoconazole. So the most effective antifungal drug is Ketoconazole, next is Fluconazole. Clotrimazole and Itraconazole have high percentages of resistance. For 739 cases of prostitutes, we found 155 fungal isolates in every species. 100 isolates (64.51%) were resistant to Clotrimazole, 124 isolates (80 %) were resistant to Itraconazole, 25 isolates (16.12 %) were resistant to Fluconazole, and 8 isolates (5.16 %) were resistant to Ketoconazole. So the most effective antifungal drug is Ketoconazole, next is Fluconazole. Clotrimazole and Itraconazole have high percentages of resistance. We can conclude that the most effective antifungal drug in housewives and prostitutes is Ketoconazole ,next is Fluconazole by in vitro method. But many times Ketoconazole is cheaper than Fluconazole. So we advise Ketoconazole as the first line drug for VVC treatment in STIs10 center, Chiangmai.
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