Candida vulvovaginitis overview: Difference between revisions
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==Overview== | ==Overview== | ||
Candida vulvovagintis is an infection of the vagina and the vestibulum, common in women in the reproductive age group. It is caused by various Candida species with Candida albicans most common pathogen followed by other species like Candida glabarta, Candida krusei etc. Patients present with vulvar pruritus, burning micturition and vaginal discharge.The diagnosis of candidal infection requires a collaboration of clinical and diagnostic findings. Patients have typical white cottage chesee like discharge with hyphae and spores demonstrated on microscopy. Patients with uncomplicated infection respond well to topical and oral azole therapy. 5 to 8% of women develop recurrent vaginitis, which is defined as more than 4 episodes in a year. These patients require a longer duration of therapy with an induction and maintenance phase. | Candida vulvovagintis is an infection of the vagina and the vestibulum, common in women in the reproductive age group. It is caused by various Candida species with Candida albicans most common pathogen followed by other species like Candida glabarta, Candida krusei etc. Patients present with vulvar pruritus, burning micturition and vaginal discharge.The diagnosis of candidal infection requires a collaboration of clinical and diagnostic findings. Patients have typical white cottage chesee like discharge with hyphae and spores demonstrated on microscopy. Patients with uncomplicated infection respond well to topical and oral azole therapy. 5 to 8% of women develop recurrent vaginitis, which is defined as more than 4 episodes in a year. These patients require a longer duration of therapy with an induction and maintenance phase. | ||
==Historical Perspective== | |||
==Classification== | |||
==Pathophysiology== | |||
==Causes== | ==Causes== | ||
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In a study of 1009 women in New Zealand, the fungus, ''Candida albicans'', was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or [[douche]]s) or internal disturbances (hormonal or physiological) can perturb the normal [[vaginal flora|flora]], constituting [[lactic acid bacteria]], such as [[lactobacilli]], and an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex, and using lubricants containing glycerin have been found to be causally related to yeast infections. [[Diabetes mellitus]] and the use of [[antibiotics]] are also linked to an increased incidence of yeast infections. Candidiasis can be sexually transmitted from men to women, but not from a woman to a man. Diet has been found to be the cause in some animals. [[Hormone Replacement Therapy]] and infertility treatments may also be predisposing factors. | In a study of 1009 women in New Zealand, the fungus, ''Candida albicans'', was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or [[douche]]s) or internal disturbances (hormonal or physiological) can perturb the normal [[vaginal flora|flora]], constituting [[lactic acid bacteria]], such as [[lactobacilli]], and an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex, and using lubricants containing glycerin have been found to be causally related to yeast infections. [[Diabetes mellitus]] and the use of [[antibiotics]] are also linked to an increased incidence of yeast infections. Candidiasis can be sexually transmitted from men to women, but not from a woman to a man. Diet has been found to be the cause in some animals. [[Hormone Replacement Therapy]] and infertility treatments may also be predisposing factors. | ||
==Differentiating candida vulvovaginitis from other Diseases== | |||
==Epidemiology and Demographics== | |||
==Risk Factors== | ==Risk Factors== | ||
Antibiotics used to treat other types of infections change the normal balance between organisms in the vagina by decreasing the number of protective bacteria. Being pregnant, having diabetes, or being obese all create conditions that help yeast grow more easily. | Antibiotics used to treat other types of infections change the normal balance between organisms in the vagina by decreasing the number of protective bacteria. Being pregnant, having diabetes, or being obese all create conditions that help yeast grow more easily. | ||
==Screening== | |||
Natural History, Complications and Prognosis== | |||
==Diagnosis== | ==Diagnosis== | ||
==History and Symptoms== | |||
==Physical Examination== | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
A small amount of the vaginal discharge is examined using a microscope (called a wet mount and [[KOH test]]). Sometimes, a culture is taken when the infection does not improve with treatment or recurs many times. | A small amount of the vaginal discharge is examined using a microscope (called a wet mount and [[KOH test]]). Sometimes, a culture is taken when the infection does not improve with treatment or recurs many times. | ||
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===Medical Therapy=== | ===Medical Therapy=== | ||
It is important to consider that ''Candida'' species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with [[antibiotic]]s against bacteria. This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition. Commonly used drugs include amphotericin, clotrimazole, nystatin, fluconazole and ketoconazole. | It is important to consider that ''Candida'' species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with [[antibiotic]]s against bacteria. This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition. Commonly used drugs include amphotericin, clotrimazole, nystatin, fluconazole and ketoconazole. | ||
==Prevention== | |||
===Primary Prevention=== | |||
==References== | ==References== | ||
Revision as of 17:48, 31 May 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Candida vulvovagintis is an infection of the vagina and the vestibulum, common in women in the reproductive age group. It is caused by various Candida species with Candida albicans most common pathogen followed by other species like Candida glabarta, Candida krusei etc. Patients present with vulvar pruritus, burning micturition and vaginal discharge.The diagnosis of candidal infection requires a collaboration of clinical and diagnostic findings. Patients have typical white cottage chesee like discharge with hyphae and spores demonstrated on microscopy. Patients with uncomplicated infection respond well to topical and oral azole therapy. 5 to 8% of women develop recurrent vaginitis, which is defined as more than 4 episodes in a year. These patients require a longer duration of therapy with an induction and maintenance phase.
Historical Perspective
Classification
Pathophysiology
Causes
Candida yeasts are usually present in most people, but uncontrolled multiplication resulting in disease symptoms is kept in check by other naturally occurring microorganisms, e.g., bacteria co-existing with the yeasts in the same locations, and by the human immune system.
In a study of 1009 women in New Zealand, the fungus, Candida albicans, was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or douches) or internal disturbances (hormonal or physiological) can perturb the normal flora, constituting lactic acid bacteria, such as lactobacilli, and an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex, and using lubricants containing glycerin have been found to be causally related to yeast infections. Diabetes mellitus and the use of antibiotics are also linked to an increased incidence of yeast infections. Candidiasis can be sexually transmitted from men to women, but not from a woman to a man. Diet has been found to be the cause in some animals. Hormone Replacement Therapy and infertility treatments may also be predisposing factors.
Differentiating candida vulvovaginitis from other Diseases
Epidemiology and Demographics
Risk Factors
Antibiotics used to treat other types of infections change the normal balance between organisms in the vagina by decreasing the number of protective bacteria. Being pregnant, having diabetes, or being obese all create conditions that help yeast grow more easily.
Screening
Natural History, Complications and Prognosis==
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
A small amount of the vaginal discharge is examined using a microscope (called a wet mount and KOH test). Sometimes, a culture is taken when the infection does not improve with treatment or recurs many times.
Treatment
Medical Therapy
It is important to consider that Candida species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with antibiotics against bacteria. This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition. Commonly used drugs include amphotericin, clotrimazole, nystatin, fluconazole and ketoconazole.