Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43: 312–316 312 Blackwell Publishing Ltd. Original Article Vaginal yeast infections Identification of yeasts in public hospital primary care patients with or without clinical vaginitis Hakan ERDEM, 1 Meral CETIN, 2 Timucin TIMUROGLU, 2 Ali CETIN, 2 Orhan YANAR 2 and Alaaddin PAHSA 3 1 Department of Infectious Diseases and Clinical Microbiology, Sivas Military Hospital, Sivas, 2 Department of Obstetrics and Gynaecology, Cumhuriyet University School of Medicine, Sivas and 3 Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Training Hospital, Ankara, Turkey Abstract Objective: Vaginal yeast infections are one of the most common female genital tract infections. Candida albicans is the most common infectious cause. Candida species other than C. albicans are being diagnosed with increasing frequency. The aim of the present study was to determine species of yeasts obtained from the vaginal fluid among public hospital primary care patients with or without clinical vaginitis and to evaluate the correlation of vaginal yeast colonisation with epidemiological and clinical features of applicants. Methods: Vaginal swabs from 622 women who underwent vaginal examination in a women’s hospital were obtained. After isolation, identification tests were carried out on 106 yeast species. Epidemiological and clinical features of women with respect to these species were evaluated. Results: Of 106 yeasts isolated, 67 C. albicans, 10 C. glabrata, seven C. kefyr (pseudotropicalis), six C. tropicalis, five C. parapsilosis, five C. krusei, three Saccharomyces boulardii, one C. guillermondii, one S. cerevisiae and one Trichosporon species were identified as yeast subtypes. Of the women with C. albicans, C. glabrata, C. kefyr, C. tropicalis, C. krusei, 60, three, one, one, and one, respectively, had symptoms of vaginitis. Of women with C. albicans, C. glabrata, C. kefyr, C. tropicalis, C. parapsilosis, C. krusei, and the other species, 27, four, three, two, one, one, and one, respectively, had clinical findings of vaginitis. Conclusion: Despite the heterogeneity of the present study group, the results support the use of vaginal culture as the most sensitive test for final diagnosis. However, a positive culture does not mean that the C. albicans is patho- genic, as it may be the normal commensal pathogen. Correlation of clinical and laboratory findings is important as it enables the administration of appropriate treatment without delay. Key words: Candida species, primary patients, public hospital, vaginal yeast infection, yeast. Introduction Primary care physicians should be proficient in diagnosing and treating vaginitis as this is among the most commonly encoun- tered problems in the outpatient care of women. Most vaginal yeast infections are caused by Candida albicans, and they account for approximately 35–40% of all vaginal infections. 1 Establishing Candida species as the cause of vaginitis can be difficult because as many as 20% of asymptomatic women have candida organisms as part of their endogenous vaginal flora. 2 Over the past two decades, there appears to have been a trend toward a greater prevalence of non-albicans species such as C. glabrata, C. krusei, C. parapsilosis, Saccharomyces cerevisiae, and C. tropicalis in fungal cultures. 3 It is reported that these non-albicans yeasts are relatively non-pathogenic and rarely, if ever, require treatment. Non-albicans yeasts are generally resistant to the usual antifungal drugs, and the over-the-counter availability of these medications is the prob- able reason that these yeasts are being selected out and encountered more frequently. 4,5 In clinical microbiology laboratories the identification of the yeasts is a neglected issue because of the complexity of the process, meaning that clinicians in daily practice will not encounter the species of the yeasts outside epidemiological studies. The only microbiological parameters will be the wet mount microscopy and positive culture. The aim of the Correspondence: Hakan Erdem, Sivas Askeri Hastanesi, Sivas 58030, Turkey. Email: hakanerdem1969@yahoo.com Received 12 July 2002; accepted 21 April 2003.