Vulvovaginal candidiasis

Contents

What is it vulvovaginal Candidiasis?

Vulvovaginal candidiasis refers to vaginal and vulvar symptoms caused by a yeast, most often Candida albicans. It affects 75% in women on at least one occasion during a lifetime.

Overgrowth of vaginal candida can result in:

White curd type vagina download
Burning sensation in the vagina and vulva
Itch eruption on the vulva and surrounding skin.

Other names used for vulvovaginal candidiasis are "vaginal yeast infection", "monilia" and "vulvovaginal yeast infection."

What Causes Vaginal Discharge?

Vaginal discharge is a normal process that maintains the mucous membrane moist vaginal lining. The amount of vaginal discharge varies depending on the menstrual cycle and arousal, and is clear and stringy in the first half of the cycle and whitish and sticky after ovulation. It can be dried over underwear leaving a slight yellowish mark. This type of discharge does not require any medication, even when it is quite abundant, as is often the case in pregnancy. It tends to reduce in quantity after menopause.

The most common microorganisms associated with abnormal vaginal discharge are:

Candida albicans and non-albicans candida species
Trichomoniasis (due to a small parasite, Trichomonas vaginalis); this causes a fishy or offensive odor and a yellow, green, or frothy discharge
Bacterial vaginosis (due to a normal imbalance bacteria living in the vagina); This causes a thin, white / gray discharge and an unpleasant odor.

Excessive vaginal discharge can also be due to injuries, foreign bodies, sexually transmitted infections, and inflammatory vaginitis

What is the cause of vulvovaginal candidiasis?

Vulvovaginal candidiasis is due to an overgrowth of yeast inside the vagina, most often C. albicans. Around 20% of non-pregnant women ages 15 to 55 harbor C. albicans in the vagina without any symptoms.

Estrogen causes the lining of the vagina to mature and contain glycogen, a substratum in which C. albicans thrives.Symptoms often occur in the second half of the menstrual cycle when there are also more progesterone. The lack of estrogens makes vulvovaginal candidiasis less common in younger and older postmenopausal women.

Nonalbicans candida species, particularly C. glabrata, are seen in 10-20% of women with recurrent vulvovaginal candidiasis.

Who gets vulvovaginal yeast infection?

Vulvovaginal candidiasis is seen more frequently in women in the reproductive age group. It is quite uncommon in prepubertal and postmenopausal women. It can be associated with the following factors:

Flares just before and during menstruation
The pregnancy
Higher dose combined oral contraceptive pill
Estrogen-based hormone replacement therapy after menopause, including vaginal estrogen cream
A course of broad-spectrum antibiotics such as tetracycline or amoxicillin.
Mellitus diabetes
Obesity
Lack of iron anemia
Immunodeficiency like HIV infection
An underlying skin condition, such as vulvar psoriasis, lichen planus, or lichen sclerosus
Other disease

What are the symptoms?

Vulvovaginal candidiasis is characterized by:

Itching, pain, and burning in the vagina and vulva.
Itching when urinating (dysuria)
Vulval edema, fissures and excoriations
Thick white curd or cottage cheese-like vaginal discharge
Bright red rash affecting the inner and outer parts of the vulva, sometimes spreading widely in the groin to include pubic areas, groin, and thighs.

The rash is believed to be secondary irritating dermatitis, preferable to primary skin infection.

Symptoms can last for a few hours or persist for days, weeks, or rarely months, and can be aggravated by sexual intercourse.

Recurrent vulvovaginal candidiasis is generally defined as four or more episodes within a year (cyclic vulvovaginitis).
Chronic, persistent vulvovaginal candidiasis can lead to lichen simplex - thickening, intense itching of the labia majora (the hair--Sporting outer lips of the vulva).

See pictures of vulvovaginal candidiasis.

How is the diagnosis of vulvovaginal candidiasis made?

The doctor diagnoses the condition by inspecting the affected area and recognizing a typical clinical appearance.

the pH of the vagina tends to be in the normal range (3.8–4.5, ie acidic), but candida can occur in a wide pH range.
The diagnosis is often confirmed by microscopy of a wet mount, vaginal swab or vaginal smear, it is best to take four weeks after the previous treatment.
In recurring cases, a swab to culture should be collected after treatment to see if C. albicans still present

Swab results can be misleading and should be repeated if symptoms suggestive of candida infection recur.

C. albicans it can be present without causing symptoms (a false positive result).
Yeast can only be grown when a certain amount is present (a false negative result).
Swabs from outside the vagina can be negative, even when yeast is present inside the vagina, and there is a typical skin rash on the vulva.
The patient's symptoms may be due to an underlying skin condition, such as lichen sclerosus.

Other tests include culture on Sabouraud chloramphenicol agar or chromagar, the germ tube test, DNA probe test by Polymerase chain reaction (PCR), and spectrometry to identify specific species of candida.

Researchers debate whether non-albican species of candida cause disease or not. If non-albicans candida is detected, the laboratory can perform susceptibility testing using disk diffusion methods to guide treatment. Sensitivity to fluconazole predicts sensitivity to other oral medications and current azoles C. glabrata It is often resistant to standard doses of oral and topical azoles.

WhWhat is the treatment for vulvovaginal candidiasis?

Appropriate treatment for C. albicans The infection can be obtained without a prescription from a chemist. If treatment is ineffective or symptoms reappear, see your doctor for examination and advice in case symptoms are due to another cause or different treatment is required.

There are a variety of effective treatments for yeast infection.

Topical antifungal pessaries, vaginal tablets or creams containing clotrimazole or miconazole - one athDays of treatment eliminate symptoms in up to 90% for women with mild symptoms. Be aware that oil-based products can weaken the latex rubber in condoms and diaphragms.
Newer formulations include butoconazole and terconazole creams.
Oral antifungal medications containing fluconazole or less commonly itraconazole may be used if C. albicans The infection is severe or recurrent. Be aware that these medications can interact with other medications, particularly statins, causing adverse events.

Vulvovaginal candidiasis often occurs during pregnancy and can be treated with topical azoles. Oral azoles are best avoided in pregnancy.

Not all genital complaints are due to candida, so if treatment is unsuccessful, it may be due to another reason for the symptoms.

Recurrent candidiasis

In about 5 to 10% of women, C. albicans the infection persists despite adequate conventional therapy. In some women, this can be a sign iron deficiency, diabetes mellitus, or an immune problem, and appropriate testing should be done. The subspecies and susceptibility of the yeast should be determined if resistance to treatment develops.

Recurrent symptoms due to vulvovaginal candidiasis are due to persistent infection, rather than reinfection. Treatment is aimed at preventing candida overgrowth that leads to symptoms, rather than complete eradication.

The following measures can be helpful.

Loose clothing - avoid occlusive nylon stockings.
Immerse yourself in a salt bath. Avoid Soap - Use soap-free cleanser or aqueous wash cream.
Apply hydrocortisone cream intermittently to reduce itching and to treat secondary dermatitis of the vulva.
Treat with an antifungal cream before each menstrual period and before antibiotic therapy to prevent relapse.
Sometimes a prolonged course of a topical antifungal agent is warranted (but these can cause dermatitis or lead to proliferation from candida not albicans).
Oral antifungal medications (usually fluconazole), which are taken regularly and intermittently (eg, 150–200 mg once a week for six months). The dose and frequency depend on the severity of the symptoms. Relapse occurs in the 50% of women with recurrent vulvovaginal candidiasis when discontinued, in which case re-treatment may be appropriate. Some women require long-term therapy.
Oral azoles may require a prescription. In New Zealand, a single dose of fluconazole is available. on the counter in pharmacies Manufacturers recommend that fluconazole be avoided in pregnancy.
Boric acid (boron) 600 mg as vaginal suppository at night for two weeks reduces the presence of candida albicans and non-albicans in the 70% of treated women. It can be irritating and is toxicsoshould be stored safely out of the reach of children and animals. Using twice a week can prevent recurrent yeast infections. Boric acid should not be used during pregnancy.

The following measures have not been shown to help.

Treatment of the sexual partner: Men can have a brief skin reaction on the penis, which disappears quickly with antifungal creams. Treating the man does not reduce the number of yeast episodes in his female partner.
Special diets low in sugar, low in yeast or high in yogurt
Put yogurt in the vagina
Probiotics (oral or intravaginal lactobacillus species)
Natural remedies and supplements (except boric acid)