Prevalence, Risk Factors and Antimicrobial Resistance Patterns of Candida albicans and Co-Infectious Agents among Female Sex Workers in Lagos, Nigeria

Background: An upsurge in the number of female sex workers (FSW) recently occurred in Lagos due to the harsh economic situation. This study is aimed at providing essential data on the carriage and antimicrobial susceptibility of Candida albicans and co-infections with other urogenital pathogens isolated from sex workers in Lagos. Methods: Two hundred female sex workers (FSWs) participated in this study conducted in Lagos, Nigeria, between September 2019 and February 2020. Urine and high vaginal swab (HVS) samples were collected from each participant, resulting in a total of 400 samples. Sociodemographic data were obtained through structured questionnaires. All samples were analyzed microbiologically, and the isolated microorganisms were subjected to standardized antibiotic and antifungal susceptibility testing. Results: Candida albicans were detected in 95 (47.5%) and 86 (43%) urine and HVS samples of FSWs, with no significant difference between the two samples. Three bacteria genera and a protozoan co-infection with C. albicans: Klebsiella-Candida, Staphylococcus-Candida, Candida-Proteus, and Trichomonas vaginalis-Candida, respectively. Risk factors like age, sexual, and hygiene behaviour predispose to vulvovaginal candidiasis. Amphotericin-B was the most effective antifungal drug against C. albicans, followed by Caspofungin and Fluconazole. Metronidazole was effective against all the T. vaginalis recovered, while Ciprofloxacin was the most effective against all bacterial strains. Conclusion: The study found a high prevalence of Candida albicans in urine and HVS samples of FSWs. Over 80% of C. albicans were susceptible to Amphotericin-B, Caspofungin, and Fluconazole, while Ciprofloxacin and Metronidazole were effective for co-infected bacterial and protozoan agents, respectively. FSWs pose a high risk for sexually transmitted infections and bacterial vaginosis transmission.