Vulvovaginal Candidiasis

INCIDENCE AND AETIOLOGY

The most common cause of vulvo-vaginal candidiasis is Candida albicans. Other non-albicans species, such as C. glabrata, account for less then 10 per cent of cases; but it is this group that may be more resistant to treatment (Kinghorn and Priestly, 1998).

Around 75 per cent of women will experience candidiasis at some time. It is usually related to pregnancy or follows antibiotic therapy. However, while sexual acquisition plays a small role in the aetiology of vulvo-vaginal candidi-asis, the infection may be passed on by male partners, who can then act as asymptomatic reservoirs of re-infection. Male partners can also develop symptomatic balanitis (Kinghorn and Priestly, 1998). Ten to twenty per cent of women of reproductive age may harbour Candida species and remain asymptomatic, and, for these women, treatment is not required.

CLINICAL FEATURES (BASHH 2002; SOUTTER 1998)

Candida albicans and the non-albicans species share common symptoms.

Table 10 Clinical features (Candida albicans and non-albicans species share common symptoms)

Table 10 Clinical features (Candida albicans and non-albicans species share common symptoms)

Signs

Symptoms

Erythema

Vulval itching

Fissuring

Vulval soreness

Discharge: can be curdy, non-offensive

Vaginal discharge

Satellite lesions

Superficial dyspareunia

Oedema

External dysuria

DIAGNOSES (BASHH, 2002) Clinical

  • Signs and symptoms as above. Microscopy
  • Gram-staining; collection of vaginal discharge from the anterior fornix or lateral vaginal wall and identification of pseudohyphae/spores. From 65 per cent to 68 per cent of symptomatic cases can be detected in this manner.
  • Saline microscopy; collection of vaginal discharge from the anterior fornix or lateral vaginal wall and identification of pseudohyphae. This gives 40-60 per cent detection.

Culture

• Sabouraud's media. Advised in all symptomatic cases where microscopy is inconclusive or species identification is helpful.

MANAGEMENT (BASHH, 2002) General advice

Avoidance of local irritants such as bubble baths Avoidance of tight-fitting synthetic clothing.

TREATMENT (BASHH, 2002) Topical treatments

° Clotrimazole pessary (500mg stat/200mg x 3 nights/100 x 6 nights) ° Clotrimazole cream 10 per cent 5g stat ° Ecoazole pessary (150mg stat/150mg x 3 nights)

Oral treatments

° Fluconazole 150mg stat ° Itraconazole 200mg bd x 1 day

Sexual partners

There is no evidence to support treatment of asymptomatic sexual partners. PREGNANCY

There is a higher incidence of asymptomatic Candida species colonisation during pregnancy (30-40 per cent). Symptomatic candidosis is also more prevalent during pregnancy. Oral therapy is contraindicated. Therefore treatment with topical azoles is recommended.

RECURRENT CANDIDOSIS (BASHH, 2002) Definition

• Four or more episodes of symptomatic candidosis annually

Prevalence

• <5 per cent of healthy women of reproductive age

Pathogenesis

  • Underlying immunodeficiency
  • Corticosteroid use
  • Frequent antibiotic use
  • Diabetes mellitus

However, pathogenesis not fully understood.

Treatment regimes

  • Fluconazole 100mg weekly x 6/12
  • Clotrimazole pessary 500mg weekly x 6/12
All Natural Yeast Infection Treatment

All Natural Yeast Infection Treatment

Ever have a yeast infection? The raw, itchy and outright unbearable burning sensation that always comes with even the mildest infection can wreak such havoc on our daily lives.

Get My Free Ebook


Post a comment