Candidal Vaginitis

Candidal Vaginitis


Introduction

  • Candida albicans is the common cause of vaginitis.
  • Candida albicans >Candida glabrata > Candida tropicalis
  • M/C vaginitis in Pregnancy, diabetes, immunocompromised people, OCP users, steroid users, antibiotic users.
  • Usually not an STD

Signs & Symptoms

  • pH < 4.5 (so it is the M/C vaginitis in acidic media) or during Pregnancy.
  • Intense pruritis.
  • Curdy white discharge (or cottage cheese-like discharge).
  • Splash dysuria.
  • Sign-Examination reveals erythema and edema of labia and vulvar skin.

Types

CDC classifies vulvovaginal candidiasis into uncomplicated and complicated.

1.      Uncomplicated

  • It is sporadic.
  • Mild to moderate in severity, likely to be caused by Candida albicans
  • It involves non-immunocompromised females.

2.      Complicated

  • It is a recurrent disease, severe, caused by non-Albicans species.
  • M/c immunocompromised females.
  • Longer treatment duration for 7-14 days needed in this case.

Risk factors

  • Pregnancy
  • Medications—Oral contraceptives( Monilial vaginitis), antibiotics, corticosteroids, cancer chemotherapy.
  • HIV and other STDs.
  • Diabetes mellitus(Vulval candidiasis )
  • Poor personal hygiene.
  • Rundown condition of health in general.

Investigation

  • IOC-Saline microscopy pseudohyphae are seen.
  • Gold standard investigation- Culture on Sabouraud’s medium or Nickerson medium.
  • Amine test/Whiff test. i.e. 10% KOH added to discharge-negative.

Treatment

  1. Non-pregnant females: Azole group of antifungals like fluconazole/miconazole which can be applied topically or given orally (150 mg, single dose).
  2. Pregnant females: Topical azole antifungals to be avoided in the first trimester
  3. Treatment of male partner-lf partner has symptoms then treatment is needed

Recurrent vulvovaginal candidiasis

  • It is defined as 4 or more episodes of candidiasis in a year.
  • Management-Fluconazole 150 mg every 3 days for 3 doses (day1, day 4, day 7 followed by 150 mg weekly for 6 months as maintenance therapy.
  • For non-albican recurrent infection = boric acid gelatin capsule intravaginally daily for 2 weeks as they are not responsive to azole treatment.

Preventions

  • Avoid broad-spectrum antibiotics unless necessary.
  • Keep the genital area clean. Use plain unscented soap.
  • Take showers rather than tub baths.
  • Wear cotton underpants or pantyhose with a cotton crotch.
  • Don’t sit around in wet clothing.
  • Avoid douches, vaginal deodorants, and bubble baths.
  • Limit your intake of sweets and alcohol.
  • After urination or bowel movements, cleanse by wiping or washing from front to back (vagina to anus).
  • Lose weight if you are obese.
  • If you have diabetes, adhere to your treatment program.

Exam Important

  • Candida albicans is the common cause of vaginitis.
  • IOC-Saline microscopy pseudohyphae are seen.
  • Gold standard investigation- Culture on Sabouraud’s medium or Nickerson medium.
  • Amine test/Whiff test. i.e. 10% KOH added to discharge-negative.
  • CDC classifies vulvovaginal candidiasis into uncomplicated and complicated.
  • Vaginal candidiasis is Associated with intense pruritus
  • Vaginal candidiasis shows Typical “Cottage cheese” discharge
  • Vulval candidiasis is associated with Diabetes mellitus
  • Vaginal candidiasis shows Buds and hyphae in KOH preparation
  • Oral contraceptives cause Monilial vaginitis
  • Diabetes mellitus, OCP user, Pregnancy & HIV are a risk factor for vaginal candidiasis
  • Commonest fungal infection of the female genitalia in diabetes is Candidial infection
  • Treatment of both partners is not recommended in vaginal candidiasis
  • Genital infection in females presenting with thick curdy or flaky discharge may be Candidiasis
  • Candidal vaginitis  is most likely to be associated with vaginal pH of 4
  • Recurrent vulvovaginal candidiasis is defined as 4 or more episodes of candidiasis in a year.
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