Candidiasis is caused by the yeast Candida. Over 90% of cases are due to the C. albicans species, most of the remainder being due to C. glabrata. About 60-70% of women experience at least one episode of candidiasis in their lifetime. Such factors as reduced immunity, steroid therapy and undiagnosed diabetes are occasionally involved in recurrent infection. It is not sexually transmitted, although some male partners develop mild, pruritic balanitis soon after intercourse, which usually resolves within 24 h.
Vulvo-vaginal candidiasis: Diagnosis
The most notable symptoms are vulval pruritis and a white vaginal discharge. Soreness and superficial dysuria and dyspareunia may also be present due to inflammation and Assuring of the vulva. The clinical findings may vary from very mild to severe vulvo-vaginitis with a typical white curdy discharge. Vulval erythema usually has a marked edge and adjacent satellite lesions may be present.
In genitourinary medicine clinics, the diagnosis of vulvovaginal candidiasis is made by detecting yeast and pseudohyphae on microscopy of vaginal discharge on a gram stain or wet slide prepared with 10% potassium hydroxide. The pH of vaginal discharge is usually less than 4.5 unless bacterial vaginosis and/or trichomonas is also present. In community settings a presumptive diagnosis can be made by clinical findings and a normal pH. Culture confirms the diagnosis and the causative species.
Vulvo-vaginal candidiasis: Treatment
Ten to twenty per cent of women of child-bearing age and 30-40% of pregnant women may have Candidiasis asymptomatically and do not require treatment. The mainstay of treatment of candidiasis is with azoles, many being available without prescription (Table Treatment of vaginal candidiasis). Topical therapy such as clotrimazole 1% cream is useful for vulvitis but should not be used alone to treat vaginal candidiasis. After treatment no specific follow-up is required. Male partners do not require treatment. Balanitis usually resolves if unprotected vaginal intercourse is avoided until the vaginal infection is treated.
Table Treatment of vaginal candidiasis
|Clotrimazole (vaginal pessary)||500 mg single dose nocte or
200 mg nocte for three nights
or 100 mg nocte for six nights
|Effect on latex contraceptives is unknown|
|Fluconazole (oral tablet)||150 mg single dose||Contraindicated in pregnancy|
|Miconazole (vaginal ovule)||1.2 g single dose nocte||Damages latex contraceptives|
|Econazole (vaginal pessary)||150 mg single dose nocte or
150 mg nocte for three nights
|Damages latex contraceptives|
|Nystatin (vaginal cream or pessary)||100 000 units nocte for 14 nights||Cream, but not the pessary, damages latex contraceptives|
Patients with recurrent infection should be examined and tested to confirm the diagnosis of candidiasis and exclude other infections. Diabetes and immunodeficiency caused by conditions such as HIV infection and corticosteroid therapy should be considered when candidiasis recurs frequently, although these are uncommon causes of candidiasis in the general population. Patients can be advised to avoid products such as bubble baths and vaginal deodorants and tight underwear made of synthetic fabric, if these appear to exacerbate the condition. Prophylactic drug regimens for recurrent infection are empirical and include clotrimazole 500 mg pessaries one every 1 or 2 weeks. Women who notice symptoms of candidiasis occurring premenstrually can be treated 2 days prior to the anticipated onset of symptoms. Women prone to candidiasis during antibiotic therapy can also be offered prophylaxis. In women with a history of recurrent candidiasis, treatment of the male partner should be considered.