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.

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