research study was used to examine the prevalence of candidiasis amongst undergraduate students of Chukwuemeka Odumegwu Ojukwu University, Uli. A total of 100 students were investigated. Clean catch midstream urine samples were used for the analysis. Standard microbiological procedures were utilized. A structured questionnaire was issued to each student to obtain their socio-demographic data. Our study found Candida albicans in 14(14%) of the urine samples. Significant candidiasis was strongly associated with being female as higher percentage of the isolates were from female students. Of the 14(14.0%) positive urine samples, 4(28.6%) were from symptomatic students, whereas 10(71.4%) were asymptomatic. Although candida vulvovaginitis occurs commonly, the reasons for its occurrence and recurrence are often unclear. Several potential risk factors have been described, including the recent use of antibiotics and oral contraceptives, uncontrolled diabetes, increased estrogen levels, impaired immune system, gastrointestinal colonization by the organism, and specific immunological defects. However, the data supporting each of these factors are conflicting, and to date, none are predictive of the infection. This study evaluates the potential risk factors of C. albicans and discusses the implications for clinical practice. We, therefore, recommend that further studies be carried out to determine the definite risk factors of candidiasis. # I. Introduction ulvovaginal candidiasis (VVC) is a fungal or yeast infection. It is found in the lower genital tract, the vulva, and the vagina of females (Sobel, 2007). When this disease is caused by Candida species, it is known as candidiasis or moniliasis. VVC can be recurrent or relapsing (Nyirjesy and Sobel, 2003). This occurs when a female experiences four or more episodes of VVC per year. Asymptomatic infections occur in about 5% of healthy women (Reset et al., 2000). VVC remains a common problem worldwide, affecting all strata of the society. The absence of rapid, simple, and inexpensive diagnostic tests continues to result in both over diagnosis and under diagnosis of VVC. Candida albicans, non-albican species, and immune suppression have led to the development of recurrent diseases, some of which do not respond to conventional antifungal drugs (Nwadiohaet al., 2013). According to McClelland et al. (2009), Candida spp. are part of the lower genital tract flora in 20%-50% of healthy women. In line with the studies of Singh (2003), C. albicans is the most frequent colonizer and is incriminated in most cases of VVC. Over the last ten years, research evidence has demonstrated an increase in the frequency of cases caused by other species of Candida. C. glabrata is also a leading cause of VVC (Ray et al., 2007). About 75% of women will experience at least one episode of VVC during their lifetime. 70 -75% of healthy adult women have had at least one episode of VVC during their reproductive life, and half of the college women will by the age of 25 years have had one case of VVC diagnosed by a physician (Sobel, 2007). VVC is not a sexually transmitted disease, because it also affects children and women who abstain themselves from sexual relationships. However, it can be transmitted sexually (de Leon et al., 2002). Diagnosis of VVC should not be based solely on patient history and a genital examination because of its low specificity of symptoms and signs. In addition, other causes like leukorrhea and pruritus vulvae mimic VVC (Geiger and Foxman, 2006). Therefore, to have a definitive diagnosis of VVC, cultural isolation and identification of Candida spp. are crucial. Previous findings have provided data on the prevalence of VVC. It is interesting to note that most previous studies focused on immune compromised subjects, especially pregnant women, diabetics, subjects on broad-spectrum antibiotic therapy, women on oral contraception with high estrogen content, and HIV-positive subjects, with few studies on otherwise immunocompetent women. Interrelationships between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH, and metabolic byproducts of these micro biomes determine a healthy vagina. L. acidophilus produces hydrogen peroxide V (as a by-product of metabolism), which is toxic to pathogens and keeps the healthy vaginal pH acidic. Alterations of the vaginal micro flora by invading pathogens or biochemical changes in the environment results in vaginitis (Odds, 2008). Changes in the vaginal environment, Candida population, and their adherence to vaginal epithelial cells enhance the germination of daughter yeast cells (Sobel, 2007). These changes and attendant multiplication of Candida cells may transform asymptomatic colonization into symptomatic infection. VVC, like many vulva diseases, has the potential to cause psychological distress and negatively impact patient's quality of life. # a) Aim of the Study Our study aims to assess the level of urethritis due to Candida albicans amongst undergraduate students of Chukwuemeka Odumegu Ojukwu University, Uli. b) Specific Objectives -Determination of the prevalence of candidiasis amongst undergraduate students -Correlation of the prevalence rates with age, sex, and other risk factors -Evaluating the effects of predisposing factors on both symptomatic and asymptomatic persons. # c) Significance of the Study Fungal infections of the urinary tract especially, those caused by Candida albicans are becoming increasingly common. Urethritis due to Candida is mostly misdiagnosed or undiagnosed, as most studies concentrate on the bacterial urinary tract infections. Studies on the epidemiology of fungal urinary tract infections are limited in apparently healthy individuals since most studies were carried out in the hospital settings amongst hospitalized patients. There are few studies that provide good databases for guiding public health practitioners on the diagnostic criteria and therapeutic pathways. # d) Limitation of the Study The study population was undergraduate students. This made the research participants selective. Collection of urine samples from students was burdensome due to the misconceptions and fear of societal ills. Some students refused to fill the questionnaires. # II. Materials and Methods # a) Study Population One hundred students of Chukwuemeka Odumegwu Ojukwu University, Uli were randomly selected for this research. Only undergraduate students in regular programs were used. Consent was obtained from the participants. # b) Sampling Procedures i. Administration of questionnaires We obtained baseline socio demographic data using well-structured questionnaires and ensured confidentiality amongst the respondents. ii. Collection of urine samples We gave well-labeled sterile wide-mouthed screw-capped plastic containers with the same unique numbers as written on the questionnaires to the respondents. Each student was instructed on how to collect clean-catch midstream urine sample. 10 ml was obtained from each student. # iii. Media used Sabouraud dextrose agar (SDA) and cornmeal agar (CMA) were used. # c) Culture and Identification of Candida albicans Sterile cornmeal agar plates were inoculated with the urine specimens and incubated at 25 o C for 72 hours. Each plate was read daily, recording the colony size, color and shapes. The isolates were subsequently streaked on sterile Sabouraud dextrose agar plates and incubated at 30 o C for 4days. The pure cultures were Gram-stained and observed microscopically using x100 oil immersion objective (WHO, 2003). i # . Germ tube test The pure cultures were suspended in test tubes containing 0.5ml human serum. These were incubated at 35 o Cfor 2 hours. A drop of the yeast-serum suspension was placed on a microscope slide and overlaid with a coverslip. This was examined microscopically for the presence of Germ tubes (Winn et al., 2006). # III. Results We present the socio-demographic characteristics of the study subjects in Table 1. Of the 100 students examined, 80(80.0%) were female and 20(20.0%) were male. Only 8 of the sampled students were married, none was pregnant. Of the sampled students 11(11.0%) knew about urinary tract infection, but only 7(7.0%) had history of urinary tract infection (previously suffered from it). 17% were symptomatic whereas the remaining 83% were asymptomatic. More so, 17(77.2%) students had used antibiotics either by prescription or self-medication, 5(22.7%) said they have not used it. 14 had Candida positive cultures making the prevalence of vulvovaginal candidiasis 14.0%. Candida positive cultures were observed mostly among ages 21-30 years [11(11.0%)]. The majority of students in this age group were in their third to final year and are sexually active. The prevalence of infection between the age groups was statistically not significant (P> 0.05). Therefore, there is no significant difference between the age groups. Out of the 100 urine samples cultured, 14 showed Candida growth, and the 14 were from female students. The prevalence of infection between the sexes was statistically not significant (P> 0.05). Therefore, there is no significant difference between sexes. IV. Discussion Our study found the prevalence of vaginal candidiasis amongst undergraduate students of Chukwuemeka Odumegwu Ojukwu University, Uli, Nigeria to be 14%. Our result is lower than that reported by Aringet al. (2012). In their study the prevalence of candidiasis was 16.5%, 21.31%, and 19 % respectively. The relatively low prevalence we observed may be attributed to adequate knowledge, good personal hygiene, and normal levels of estrogens and corticoids amongst undergraduate students. Our result is however, in agreement with the studies of Fernández et al. (2004). We observed candidiasis in students between ages 20 -30 [ There was no statistically significant relationship between the prevalence of VVC with age (P>0.05) or clinical symptoms of ill health (P>0.05). This may be due to recurrent infections that might have contributed to the resistance of the vagina to candidiasis. Subjects with vulvovaginal discomfort had a higher percentage of Candida-positive cultures (29.1%) than those with no vulvovaginal discomfort (11.9%). This report is in agreement with the findings of Jombo et al. (2010). It is reasonable to believe that young women with genital discomfort consult health care centers more often than women without such symptoms (Jombo et al., 2010). All subjects with positive Candida culture results had already been on antibacterial therapy prior to their hospital visit -28 (100%). This finding is in conformity with the fact that prolonged antibacterial use usually affects vaginal bacteria micro flora population and biochemical activity (mainly L. acidophilus), which thus increases vaginal pH as a result of reduced CO 2 production. This feature, alongside other factors (such as hormonal factors), encourages Candida overgrowth, consequently leading to vulvovaginitis (Bauters et al., 2002). Although the widespread use of antibiotics has been suggested as one of the major factors contributing to the rising incidence of VVC, (Foxman et al.,2008)some case-control studies (Geiger et al.,2006) found no evidence of an association between antibiotic agents and symptomatic VCC, whereas others reached the opposite conclusion (Spinillo et al.,2009). # V. Conclusion There is a need to create awareness of the involvement of Candida spp. in genital discomfort, especially vaginal candidiasis, amongst undergraduate students with or without notable signs and symptoms. It is worthwhile to consider culture test as adjunctive in combination with clinical symptoms in the definitive diagnosis of VVC. More work is required to build on findings generated from this study. # VI. Recommendations We recommend the following: ? The presence of candidiasis among apparently healthy individuals should not be neglected. 1Gender 2Age (years)No. ExaminedNo. PositivePrevalence(%)15-20733.021-255466.026-303755.0Above 30200.0Total1001414.0 4Clinical presentationNo. examinedNo. positivePrevalenceSymptomatic17(17.0%)4(28.6)23.5(66.2%)Asymptomatic83(83.0%)10(71.4)12.0(33.8%)Total100(100.0%)14(100.0%)35.5(100.0%) D D D D ) C( © 2020 Global JournalsPrevalence of Candidiasis amongst Undergraduate Students of COOU, Uli, Nigeria * Prevalence of Candidaalbicans and bacterial vaginosis in asymptomatic pregnant women in South Yorkshire AAAkinbiyi RWatson WPFeyi United Kingdom. Archive of Gynecology 278 2008 * Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin City, Edo estate EAkortha OChikwe ONwaugo Nigeria. African Journal of Microbiological Research 3 11 2009 * Prevalence of asymptomatic co-infection of Candidiasis and vaginal Trichomonas among pregnant women in Abakaliki MNAlo CAnyim AKOnyebuchi ECOkonkwo Journal of Natural Sciences 2 7 2012 * Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis DRAndes NSafdar JWBaddley GPlayford ACReboli JHRex Clinical Infectious Diseases 54 8 2012 * Incidence of vaginal candidiasis in leucorrhoea in women attending in orthopedic of gynecology and obstetrics department BJAring PJMankodi JHJasani International Journal of Biomedical and Advanced 3 12 2012 * Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women TGBauters MADhont MITemmerman HJNelis American Journal of Obstetrics and Gynecology 187 3 2002 * Virulence factors of Candida albicans RACalderone WAFonzi Trends in 9 2001 * Vaginal candidiasis: evolving trends in the incidence and treatment of non-Candida albicans infection. Current Problems in Obstetrics GCauwenbergh Gynecology and Fertility8 2000 241 * Micafungin: a new echinocandin PHChandrasekar JDSobel Clinical Infectious 42 8 2006 * An epidemiological surgery of vulvovaginal candidiasis in Italy SCorsello ASpinillo GOsnengo European Journal of Obstetrics, Gynecology, and Reproductive 110 1 2003 * The regulation of filamentous growth in yeast PJCullen GFSprague 2012 190 * Local treatment of vulvovaginal candidosis: general and practical considerations JDas-Neves EPinto BTeixeira GDias PRocha TCunha 2008 68 * Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes EMDe Leon SJJacober JDSobel BFoxman Bio Med Central Infectious Diseases2 2002 * Small intestinal fungal overgrowth AErdogan SSRao Current Gastroenterology 17 4 16 2015 * Chronic vulvovaginal candidiasis DAEschenbach The New England Journal 351 9 2004 * Vaginal candidosis: epidemiological and etiological factors JFerrer International Journal of Gynecology 71 1 2000 * Over-thecounter antifungal drug misuse associated with patient diagnosed vulvovaginal candidiasis DGFerris PNyirjesy JDSobel DSoper APavletic MSLitaker Obstetrics 99 3 2002 * Candida-host interactions in Human Immune Deficiency Virus disease: relationships in or opharyngeal candidiasis PLFidel Advances in Dental 19 2006 * Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey BFoxman JVMarsh BGillespie JDSobel Journal of Women 7 9 2008 * Risk factors for vulvovaginal candidiasis: a case-control study among university students AMGeiger BFoxman 2006 7 * Biofilm formation in clinical Candida isolates and its association with virulence FHasan IXess XWang NJain BCFries Microbes and Infection 11 2009 * Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry DLHorn DNeofytos EJAnaissie JAFishman WJSteinbach AJOlyaei KAMarr MAPfaller CHChang KMWebster Clinical Infectious Diseases 48 2009 * Rapid susceptibility testing and microcolony analysis of Candida species cultured and imaged on porous aluminum oxide CJIngham SBoonstra SLevels MDe Lange JFMeis PMSchneeberger Journal of Public 1 7 2012 * Symptomatic vulvovaginal candidiasis and genital colonization by Candida species in Nigeria GTJombo SOOpajobi DZEgah EBBanwat APDenen Journal of Public Health 2 6 2010 * Diagnosis and management of fungal urinary tract infection CAKauffman Infectious Disease Clinics of North 28 1 2013 * Oral and maxillofacial surgery CKerawala CNewlands 2010 Oxford University Press London * Anidulafungin compared with fluconazole in severely ill patients with candidemia and other forms of invasive candidiasis DHKett AFShorr ACReboli Critical 15 5 253 2011 * Time to positivity of blood cultures of different Candida species causing fungaemia CCLai CYWang WLLiu YTHuang PRHsueh Journal of Medical Microbiology 61 2012 * The incidence of Candida albicans in the vagina of "healthy young women". How often do they have symptoms? Possible etiological factors MLeegaard Acta Obstetricia Et Gynecologica 63 1 2004 * New Rapid Blood Test Could Cut Mortality RLewis Candida Medscape Medical News Apr 25 2013. Apr 30, 2013 * Vulvovaginal candidiasis JMarrazzo British Medical 3 4 2002 * FCMartini WCOber CWGarrison KWelch RTHutchings Fundamentals of Anatomy and Physiology. Fifth Edition Prentice-Hall Eaglewood Cliffs, United States of America 2001 * Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment NMartins ICFerreira LBarros SSilva MHenriques 2014 177 * Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis RSMcclelland BARichardson WMHassan Journal of Infectious 199 12 2009 * Reproductive tract infection in women of reproductive age group in Sitapur/ Shahjahanpur district of Uttar Pradesh DNandan YPGupta VKrishnan ASharma SKMisra Indian Journal of Public 5 1 2011 * Prevalence of vaginal candidiasis and determination of the occurrence of Candida species in pregnant women attending the antenatal clinic of Thika District Hospital MNelson WWanjiru MWMargaret Kenya. Open Journal of Medical Microbiology 3 2013 * Suppression of anti-Candida activity of murine neutrophils by progesterone in vitro: A possible mechanism in pregnant women's vulnerability to vaginal candidiasis TNohmi SAbe KDobashi STansho HYamaguchi Microbiology and Immunology 39 2005 * Vaginal candidiasis and its risk factors among women attending a Nigerian teaching hospital SINwadioha EONwokedi JEgesie HEnejuo Nigerian Postgraduate Medical Journal 20 2013 * Chronic vulvovaginal candidiasis PNyirjesy American Family 63 4 2001 * Vulvovaginal candidiasis PNyirjesy JDSobel Obstetrics and Gynecology Clinics of North 30 4 2003 * Candida and Candidiasis: A Review and Bibliography. Second Edition FCOdds 2008 Bailliere Tindall Press London * The distribution frequency of Candida species in the genitourinary tract among symptomatic individuals in Nigeria cities FIOkungbowa OSIsuehuemhen ADede Revista Iberoamericana de Micologia 20 2003 * Vulvovaginal candidiasis among women in makkah city, Saudi Arabia AAOmar Research Journal of Medical 7 4 2001 * Clinical Practice Guideline for the Management of Candidiasis PGPappas CAKauffman DRAndes CJClancy KAMarr ZLOstrosky Clinical Infectious 62 4 2016 * Clinical practice guidelines for the management of candidiasis PGPappas CAKauffman DAndes DKBenjamin TFCalandra JEEdwards Clinical Infectious 48 5 2009 * Guidelines for treatment of candidiasis PGPappas JHRex JDSobel Clinical Infectious Diseases 38 2 2004 * Effects of reproductive hormones on experimental vaginal Candidiasis LFPaul CJessica SChad Journal of Infection 68 2 2000 * Prevalence of Candidaglabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis DRay RGoswami UBanerjee Diabetes 30 2 2007 * Risk factors for Candida vulvovaginitis BDReed Obstetrical and Gynecological 47 8 2002 * Differentiation of Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis infections of the vagina BDReed WHuck PZazove The Journal of Family 28 6 2009 * Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America JHRex TJWalsh JDSobel Clinical Infectious 30 4 2000 * Treatment of recurrent vulvovaginal candidiasis ERingdahl American Family 61 11 2000 * Adherence and biofilm formation of non-Candida albicans Candida species SSilva MNegri MHenriques ROliveira DWWilliams JAzeredo Trends in 19 2011 * Treatment of vulvovaginal candidiasis SISingh Clinical Reviews 136 9 2003 * Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis JDSobel N Engl J Med 351 9 2004 * Vulvovaginal candidosis JDSobel The 369 2007 * The impact of oral contraception on vulvovaginal candidiasis ASpinillo ECapuzzo SNicola FBaltaro AFerrari AMonaco Contraception 51 5 2005 * Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis ASpinillo ECapuzzo SAcciano ADe Santolo FZara American Journal of Obstetrics 180 1 2009 * Vaginal and vulval candidiasis HWillacy CJackson 2011. May 17. 2015 * Koneman's Color Atlas and Textbook of Diagnostic Microbiology WCWinn SDAllen WMJanda EWKoneman GWProcop PCSchreckenberger GLWoods 2006 Lippincott Williams and Welkins Press United States of America Sixth Edition