Bacterial and Fungal Profiles in Mixed Vaginitis Versus Bacterial Vaginosis

OBJECTIVES: Mixed vaginitis (MV) and the co-occurrence of bacterial vaginosis (BV) and vaginal Candida spp. remain insufficiently defined. This study aimed to compare the clinical and microbiological characteristics of women with BV alone and those with concomitant BV and morphologic evidence of Candida infection. METHODS: This cross-sectional study, conducted in accordance with the STROBE guidelines, evaluated women diagnosed using Gram-stained smears and liquid-based cytology: 118 patients with BV alone based on Nugent criteria; and 65 patients with MV (BV based on Nugent criteria and Candida species). RESULTS: Women in the BV group were more frequently asymptomatic [55.1% (65/118) vs. 26.2% (17/65); p=.0001]. Normal colposcopic results were observed more frequently in the BV group [99/118 (83.9%) vs. 17/65 (26.2%); p=.0001]. Women in the MV group more commonly reported discharge with itching [21/65 (32.2%) vs. 4/118 (3.4%); p=.0001] and exhibited a significantly higher prevalence of colpitis [47/65 (72.3%) vs. 10/118 (8.5%); p=.0001). Megasphaera type 1 [99/118 (83.9%)], Mobiluncus spp. [49/118 (41.5%)], and BV-associated bacteria (BVAB2) [86/118 (72.9%)] were more frequently observed in the BV group (p<.05), while a higher prevalence of lactobacilli was noted in the MV group (58.5%; p<.05). Candida albicans was predominant in the MV group (89%). CONCLUSIONS: MV was associated with pruritus, vaginal discharge, and colpitis, whereas BV was more often asymptomatic and associated with specific anaerobic bacteria. Both lactobacilli and anaerobes are often present in MV, with C. albicans being the most common fungus.