Candida Vaginitis

Candida species are a common cause of vaginitis. While there are no reliable figures as to prevalence of vulvovaginal candidiasis (VVC) because the disease is not reportable, it is estimated that 75 percent of women will experience at least one infection during their childbearing years (with the highest attack rate during the third trimester of pregnancy), making it the second commonest vaginal infection.2 A small subpopulation of women, less than 5 percent, have repeated episodes of disease with no apparent factors being responsible for recurrent infection.

The organism can be isolated from up to 20 percent of asymptomatic, healthy women of childbearing age, some of whom are celibate. Therefore, this infection is not considered a sexually transmitted disease (STD), although it can be transmitted that way. Factors that favor increased rates of asymptomatic vaginal colonization include pregnancy, oral contraceptives, uncontrolled diabetes mellitus, and frequent visits to STD clinics (perhaps as a result of antimicrobial therapy). It is rare in premenarchial girls4 and has a decreased incidence after menopause unless replacement estrogen is being used, emphasizing the hormonal dependence of VVC. Immunity to Candida infections is primarily cell mediated.

Candida albicans strains account for 85 to 90 percent of those isolated from the vagina, while Candida glabrata and Candida tropicalis are the commonest non-albicans strains and are often more resistant to conventional therapy. Candidal organisms gain access to the vaginal lumen and secretions predominantly from the adjacent perianal area. Candidal organisms must first adhere to the vaginal epithelial cells for colonization to take place, and C. albicans adheres in greater numbers than do other strains.

Factors that enhance the germination of Candida (e.g., pregnancy and estrogen therapy) tend to precipitate symptomatic vaginitis, while conditions that inhibit germination (normal flora and local mucosal cell-mediated immunity) prevent acute vaginitis in carriers of yeast. The growth of Candida is held in check by the normal vaginal flora, and symptoms of vaginitis usually occur only when the normal balance is upset. Conditions that inhibit growth of normal vaginal flora, particularly Lactobacillus species (e.g., systemic antibiotics, especially broad-spectrum agents), diminish the glycogen stores in vaginal epithelial cells (e.g., diabetes mellitus, pregnancy, oral contraceptives, and hormonal replacement therapy), or increase the pH of vaginal secretions (e.g., menstrual blood or semen) may cause increased colonization by Candida, which is an opportunistic organism, and subsequent symptomatic infection. Tight-fitting, particularly synthetic, undergarments may also contribute to the problem because of increased temperature, moisture, and local irritation.

Clinical symptoms include leukorrhea, severe vaginal pruritus (commonest symptom), external dysuria, and dyspareunia. Symptoms vary in severity, but exacerbation is frequently seen in the week prior to menses or with coitus. Odor is unusual.

Gynecologic examination may reveal vulvar erythema and edema, vaginal erythema, and, occasionally, thick "cottage-cheese" discharge, seen most often in pregnant patients. The discharge may vary from none to watery to homogeneously thick.

The diagnosis of Candida vaginitis is made by microscopically examining a wet mount or normal saline sample of vaginal secretions for yeast buds and pseudohyphae (Fig, 104-1; sensitivity 40 to 60 percent). Two drops of 10% KOH added to the vaginal scretions dissolves the vaginal epithelial cells, leaving yeast buds and pseudohyphae intact, increasing the sensitivity (80 percent) of microscopic examination and yielding almost 100 percent specificity. Culture should only be done in a symptomatic patient with negative findings on microscopic examination.3

Most treatment regimens (T§ble...104z3) are effective in relieving symptoms, but recurrence of infection is common.3 The topically applied azole drugs are more effective than nystatin, with relief of symptoms in 80 to 90 percent of patients who complete treatment. Creams, lotions, sprays, vaginal tablets, suppositories, and coated tampons are all equally efficacious, and the choice of vehicle should depend on the patient's preference. The azole drugs are all available over the counter (OTC) with durations of 1, 3, or 7 days. One-day treatment with oral fluconazole is as effective as use of topical preparations. 78 Partners should not be treated unless the woman has frequent recurrences.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

Get My Free Ebook


Post a comment