Comparative virulence traits of Candida spp. in pregnant and non-pregnant women with vulvovaginal candidiasis

Abstract Vulvovaginal candidiasis (VVC) is highly prevalent in women of reproductive age and represents an important public health concern. Its high incidence and recurrence, together with antifungal resistance and therapeutic limitations during pregnancy, underscore the need for a better understanding of Candida -related phenotypes. By identifying the predominant Candida species causing VVC, this study aimed compare antifungal susceptibility and virulence-associated phenotypes among isolates from pregnant and non-pregnant women. Candida spp. isolates were obtained from women with VVC who were pregnant (G1), non-pregnant (G2), or non-pregnant with recurrent VVC (G3). Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility was evaluated using standardized testing, while biofilm formation and metabolic activity were assessed by in vitro assays. In vivo virulence was evaluated using the Tenebrio molitor model. A total of 29 isolates were recovered, predominantly Candida albicans , followed by Candida glabrata , Candida parapsilosis , and Candida tropicalis . VVC was more frequent in pregnant women than non-pregnant women. Although antifungal susceptibility varied between isolates, some exhibited resistance or reduced susceptibility to one or more drugs, particularly azoles. Biofilm phenotypes also varied, with alterations in biomass production and metabolic activity observed across isolates. G1 isolates induced high mortality rates in the T. molitor model, indicating pronounced in vivo virulence. Overall, these findings highlight the predominance of C. albicans in VVC, including pregnancy women and recurrent cases, and demonstrate heterogeneous antifungal susceptibility alongside by distinct biofilm and virulence phenotypes. The marked virulence observed in G1 and biofilm alterations in G1, G2, and G3 underscore the complex pathogenic profiles of VVC isolates.