<b>Association Between Recurrent Vulvovaginal Candidiasis and Glycemic Control in Women With Undiagnosed Prediabetes</b>

Background: Recurrent vulvovaginal candidiasis is a common gynecologic problem that causes repeated symptoms, frequent healthcare visits, and substantial impairment in quality of life. Although diabetes is a recognized risk factor for candidal infection, abnormal glucose metabolism may remain undetected in women presenting with recurrent disease. Objective: To determine the prevalence of recurrent vulvovaginal candidiasis among symptomatic women attending a tertiary care gynecology clinic, assess fasting blood glucose and glycated hemoglobin levels in affected patients, and evaluate the association between glycemic status and infection recurrence in women without a prior diagnosis of diabetes. Methods: This analytical cross-sectional study was conducted in the gynecology outpatient department of a tertiary care hospital in Balochistan, Pakistan. Women presenting with symptoms suggestive of vulvovaginal candidiasis were clinically assessed with laboratory support. Recurrent vulvovaginal candidiasis was defined as three or more symptomatic episodes within one year. Women with known diabetes and major confounding conditions were excluded. Fasting plasma glucose and HbA1c were measured in eligible women, and data were analyzed using SPSS version 26 with chi-square testing and group mean comparisons. Results: Among 412 symptomatic women, vulvovaginal candidiasis was confirmed in 214 (51.9%), and 132 (32.0% of symptomatic attendees; 61.7% of confirmed cases) had recurrent disease. Of the recurrent cases, 68 (51.5%) had normal glycemic values, 46 (34.8%) had prediabetes, and 18 (13.6%) had diabetes-range values, giving an overall dysglycemia prevalence of 48.5%. Mean fasting glucose and mean HbA1c were significantly higher in women with abnormal glycemic status than in those with normal glycemic values (111.6 ± 8.9 mg/dL vs 89.4 ± 7.1 mg/dL; 5.98 ± 0.29% vs 5.31 ± 0.24%, respectively; p < 0.001). A significant association was observed between worsening glycemic category and higher recurrence frequency (p < 0.001). Conclusion: Recurrent vulvovaginal candidiasis showed a significant association with previously unrecognized abnormal glycemic status in women with no prior diagnosis of diabetes. Opportunistic screening with fasting blood glucose and HbA1c in women presenting with recurrent candidiasis may support earlier detection of prediabetes and diabetes in gynecology practice