## Most Common Cause of Vulvovaginal Candidiasis **Key Point:** Candida albicans accounts for 80–90% of all vulvovaginal candidiasis cases, making it the overwhelming commonest pathogen in this site. ### Epidemiology of Candida Species in Vaginal Infections | Candida Species | Frequency in VVC | Clinical Features | Risk Factors | |---|---|---|---| | **C. albicans** | 80–90% | Acute vulvovaginitis, pseudohyphae on microscopy | Diabetes, antibiotics, immunosuppression | | C. glabrata | 5–10% | Often asymptomatic colonization, resistant to azoles | Recurrent infections, older age | | C. tropicalis | 2–5% | Systemic infection risk higher than albicans | Immunocompromised hosts | | C. auris | <1% | Nosocomial, multidrug-resistant | Healthcare-associated, ICU patients | **High-Yield:** C. albicans is the default answer for any uncomplicated vulvovaginal candidiasis question unless the stem specifies recurrent infection, azole resistance, or immunocompromised status. ### Why C. albicans Dominates 1. **Virulence factors:** Produces proteinases, phospholipases, and can switch between yeast and hyphal forms 2. **Vaginal colonization:** Normal commensal in 20–30% of healthy women; overgrowth occurs with disrupted normal flora 3. **Predisposing factors:** Diabetes (elevated glucose in vaginal secretions), broad-spectrum antibiotics, pregnancy, oral contraceptives **Clinical Pearl:** The presence of pseudohyphae on wet mount is pathognomonic for candidiasis and confirms the diagnosis; culture is unnecessary for uncomplicated cases. **Mnemonic:** **CATS** for common Candida in vaginal disease: - **C**. albicans (most common) - **A**. auris (emerging nosocomial threat) - **T**. tropicalis (immunocompromised) - **S**. species (glabrata — recurrent/resistant) [cite:Jawetz, Melnick & Adelberg's Medical Microbiology 28e Ch 45]
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