{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T20:56:07Z","timestamp":1793998567535,"version":"4.8.0"},"reference-count":30,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2024,8,9]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Azoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-\n                      <jats:italic>Candida albicans<\/jats:italic>\n                      yeasts (NCAY) and azole-resistant\n                      <jats:italic>C. albicans<\/jats:italic>\n                      cases, their prevalence was calculated from cultures for yeasts in women with complicated\/RVVC over 3 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated\/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated\/RVVC, RVVC, with 1828 (33.5%) growing yeasts.<\/jats:p>\n                    <jats:p>\n                      Over 85% of yeasts each year were\n                      <jats:italic>C. albicans<\/jats:italic>\n                      , however the proportion declined yearly with an increase in NCAY species.\n                      <jats:italic>Nakaseomyces glabrata<\/jats:italic>\n                      was the most frequent NCAY species isolated, increasing from 2.8% in 2018\u201319 to 6.8% in 2020\u201321. Total NCAY species increased from 6.0% in 2018\u201319 to 12.6% in 2020\u201321. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018\u201319 to 7.7% in 2019\u201320 and 9.6% in 2020\u201321. Most resistance was in\n                      <jats:italic>C. albicans<\/jats:italic>\n                      and the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      There was a significant increase in the prevalence of NCAY and fluconazole-resistant\n                      <jats:italic>C. albicans<\/jats:italic>\n                      in complicated\/RVVC cultures over these 3\u2009years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2024-056186","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T20:00:12Z","timestamp":1728417612000},"page":"21-26","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Increasing rate of non-\n                    <i>Candida albicans<\/i>\n                    yeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom"],"prefix":"10.1136","volume":"101","author":[{"given":"Jennifer C","family":"Ratner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9865-0834","authenticated-orcid":false,"given":"Janet","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Armitage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4811-2496","authenticated-orcid":false,"given":"Richard Christopher","family":"Barton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"2025012910100553000_101.1.21.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30103-8"},{"key":"2025012910100553000_101.1.21.2","doi-asserted-by":"publisher","DOI":"10.1177\/0956462420943034"},{"key":"2025012910100553000_101.1.21.3","doi-asserted-by":"crossref","unstructured":"Workowski KA , Bachmann LH , Chan PA . 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M44: Method for Antifungal Disk Diffusion Susceptibility Testing of Yeasts, 3rd Edition. 2018: ISBN Number: 978-1-68440-031-7."},{"key":"2025012910100553000_101.1.21.19","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01651-18","article-title":"Method-dependent epidemiological cutoff values for detection of triazole resistance in Candida and Aspergillus species for the sensititre YeastOne colorimetric broth and Etest Agar diffusion methods","volume":"63","author":"Espinel-Ingroff","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2025012910100553000_101.1.21.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01935.x"},{"key":"2025012910100553000_101.1.21.21","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05025-11"},{"key":"2025012910100553000_101.1.21.22","doi-asserted-by":"crossref","DOI":"10.1128\/aac.02366-21","article-title":"Determining susceptibility in Candida vaginal isolates","volume":"66","author":"Sobel","year":"2022","journal-title":"Antimicrob Agents Chemother"},{"key":"2025012910100553000_101.1.21.23","unstructured":"Royal College of General Practitioners (RCGP) e-learning\/ British Association for Sexual Health and HIV (BASHH) . Investigating infection in abnormal vaginal discharge. 2020. 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