Each year, 5 to 10 million women worldwide seek gynecological care for vaginitis. It is estimated that 70–75% of women of reproductive age will experience at least one episode of vulvovaginal candidiasis (VVC) in their lifetime, and 40–50% will have recurrences. VVC presents with classic signs and symptoms such as acute vulvar and vaginal inflammation, intense pruritus, thick white discharge with odor, dysuria, and pelvic discomfort. Biofilm plaques adhered to the vaginal mucosa are characteristic and represent a major virulence factor of Candida . This process involves adhesion mediated by adhesins, inducing morphological transition and increased expression of hyphal proteins and extracellular matrix, conferring stability and resistance. To collect vaginal discharge samples from patients with recurrent candidiasis; perform molecular identification via quantitative PCR; and evaluate fluconazole resistance and biofilm-forming capacity of clinical isolates. Samples were collected from patients treated at a Primary Healthcare Unit in Ribeirão Preto, São Paulo. Vaginal fluid was obtained using sterile swabs from the vaginal walls. The study was approved by the Research Ethics Committee (CAAE: 75654223.2.0000.5498). Among 30 analyzed samples, one patient presented dual infection with simultaneous isolation of two strains—one Candida albicans and one non-albicans species. Both samples were classified as fluconazole-resistant according to CLSI guidelines. In vitro biofilm-formation capacity showed intense growth. The patient questionnaire indicated high-risk sexual behavior, including multiple partners and infrequent condom use. Molecular identification of clinical isolates is crucial, as it may reveal fluconazole resistance associated with biofilm formation. These findings highlight the importance of integrated strategies including sexual education to modify behavioral risk factors and the use of more specific laboratory tests to individualize diagnosis and treatment.
Monteiro et al. (2026) studied this question.