CANDIDIAL (MONILIAL) VAGINITIS

EPIDEMIOLOGY:

• Candida albicans is the common cause of vaginitis.
• Risk factors altering the immune response include
  • Pregnancy
  • Medications—Oral contraceptives( Monilial vaginitis), antibiotics, corticosteroids, cancer chemotherapy
  • HIV and other STDs
  • Diabetes mellitus(Vulval candidiasis )
  • Poor personal hygiene
  • Run down condition of health in general.

SIGNS AND SYMPTOMS:

Severity of the following symptoms varies between women and from time to time in the same woman.

• Intense pruritis
• White, “curdy” vaginal discharge, (resembles lumps of cottage cheese).
• The odor may be unpleasant, but not foul.
• Swollen, red, tender, itching vaginal lips (labia) and surrounding skin.
• Burning on urination.
• Change in vaginal color from pale pink to red.

DIAGNOSIS:

Clinical data

• Complaints of pruritus, burning, dysuria
• Evidence of vulvar erythema, oedema, scratch marks
• Discharge: whitish, flaky or curd-like 
• Vaginal pH : 4.5

INVESTIAGTIONS:

•  KOH treated wet mount of the vaginal discharge helps to dissolve all cellular debris, leaving behind the resistant hyphae and spores of candida.

Culture:

• Sabouraud’s agar—Presence of discrete creamy rounded colonies appear in 48–72 h, giving a typical yeast-like odour.
• Nickerson’s Medium :Colonies appear in 48–72 h as brown-black discrete round colonies.

MANAGEMENT:

• Preventive measures
  • Improve personal hygiene
  •  Discontinue offending medications
  • Control diabetes
• Antifungal creams or pessaries for 7–14 days.Oral antifungal agents—Flucanazole – single oral dose of 150 mg.
• Clotrimazole, Miconazole, Terconazole, Butoconazole

• Avoid broad-spectrum antibiotics unless absolutely necessary.
• Keep 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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