CANDIDIAL (MONILIAL) VAGINITIS
| A | Risk is not increased in pregnancy | |
| B |
Associated with intense pruritus |
|
| C |
Typical “Cottage — cheese” discharge occurs |
|
| D |
b and c both |
True about vaginal candidiasis :
| A |
Risk is not increased in pregnancy |
|
| B |
Associated with intense pruritus |
|
| C |
Typical “Cottage — cheese” discharge occurs |
|
| D |
b and c both |
Ans. is D. i.e. b and c both
- 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.
| A |
Cottage cheese like secretions are seen |
|
| B |
Intense pruritus |
|
| C |
Most common in non-pregnant women |
|
| D |
Buds and hyphae seen in KOH preparation |
Ans. is C. i.e. Most common in non-pregnant women
- Candidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates.
- It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics, and corticosteroids.
- It is also seen in patients with diabetes.
- It causes a profuse discharge and intense pruritus with soreness of vagina and dysuria.
- Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identified.
- A 10% KOH smear shows the buds and hyphae of the Candida organism.
- Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with the cream of the same medication for External use.
| A |
Monilial vaginitis |
|
| B |
Pituitary adenoma |
|
| C |
Ca uterus |
|
| D |
B and C |
Ans. is D i.e. B and C.
Adverse Effects of Oral Contraceptive:
Minor:
• Intermenstrual spotting- first 3 months
• Nausea, vomiting, lack of appetite,
• Breakthrough bleeding
• Breast tenderness, vaginal discharge
• Headache, migraine Chloasma
• Weight gain Acne, Oily skin
Major:
• Cardiovascular disease, Stroke, Venous Thromboembolism
• Vaginal moniliasis
• Ca. Endocervix: if used for> 5years, dysplasia more common
• Cancer – Breast Ca(controversial), Ca cervix, Liver Ca
• Diabetes & Gall stones
• Affects lactation
A patient presented with intense vulvar pruritus, a white curd-like, cheesy vaginal discharge, and vulvar erythema. Candidiasis was diagnosed. Which among the following is NOT a risk factor for vaginal candidiasis?
| A |
Diabetes mellitus |
|
| B |
Hypertension |
|
| C |
Human Immunodeficiency Virus (HIV) infection |
|
| D |
Pregnancy |
Ans. is B. i.e. Hypertension
Risk factors of a candida infection include:
- Diabetes mellitus
- Human immunodeficiency virus [HIV]
- Obesity
- Pregnancy
- Medication (antibiotics, corticosteroids, oral contraceptives)
- Chronic debilitation
| A |
OCP user |
|
| B |
IUCD user |
|
| C |
Diabetes |
|
| D |
Pregnancy |
Ans. is B. i.e. IUCD user
- 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.
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.
| A |
Cryptococcal |
|
| B |
Madura mycosis |
|
| C |
Candidal |
|
| D |
Aspergillosis |
Ans. is C. i.e. Candidal
- 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.
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.
Treatment of both partners is recomended in A/E :
| A | Candida infection | |
| B |
Gardenella |
|
| C |
Herpes |
|
| D |
c and a |
C i.e. Herpes > A i.e. Candida infection
|
STD |
Required T/t of Sexual partner |
|
Herpes |
– None ie Avoid sex & use condomes |
|
Candida |
– None; ie only topical t/t if Candidal dermatitis of penis is detected |
|
Bacterial Vaginosis (ex. gardnerella) |
– T/t given only when STD present – T/t of parterner does not prevent recurrance of ds. |
|
Trichomonas vaginalis |
– Sexual partner is always treatedQ as it reduces risk of recurrance reservoir. |
| A | Addison’s disease | |
| B |
Cushing’s disease |
|
| C |
Diabetes mellitus |
|
| D |
Acromegaly |
Ans. C i.e. Diabetes mellitus
- Candida albicans is the common cause of vaginitis.
- M/C cause is Candida albicans >Candida glabrata > Candida tropicalis.
- M/C vaginitis in Pregnancy, diabetes, immunocompromised people, OCP users, steroid users, antibiotic users.
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.
| A |
Candidiasis |
|
| B |
Trichomoniasis |
|
| C |
Syphilis |
|
| D |
Gonorrhea |
Ans. A i.e. Candidiasis
- 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.
| A |
Candidiasis |
|
| B |
Trichmoniasis vaginitis |
|
| C |
Early carcinoma of the vulva |
|
| D |
All of the above |
Ans. is D. i.e. All of the above.
Pruritus vulvae is itchiness of the vulva.
Causes: Itch due to infections
- Candida albicans infection (vulvovaginal thrush) is the most important microorganism to consider in a postpubertal woman with vulval itch.
- Bacterial vaginosis causes a frothy, malodorous discharge, and uncommonly causes vulval itch, possibly as a result of contact dermatitis.
- Genital viral warts are often itchy.
- Pinworms can reside in the vagina or anus and cause itch when they exit at night.
- Infections that rarely cause vulval itch include cytolytic vaginosis (associated with vaginal lactobacilli) and trichomoniasis.
Itch due to an inflammatory skin condition
Irritant contact dermatitis is the most common cause of an itchy vulva at all ages. It may be due to diverse causes, including:
- Age-related prepubertal or postmenopausal lack of estrogen
- Underlying tendency to atopic dermatitis
- Scratching for another reason
- Friction from skin folds, clothing, activity, or sexual intercourse
- Moisture due to occlusive underwear
- Urine and/or feces
- Soap or harsh cleanser
- Frequent washing
- Inappropriate or unnecessary chemical applications, including over-the-counter or prescribed medications
- Fissuring of the posterior fourchette
- Normal, excessive or infected vaginal secretions
The severe vulval itch may be due to:
- Lichen simplex
- Lichen sclerosis
- Lichen planus
Other common skin disorders that may cause vulval itch include:
- Psoriasis
- Seborrhoeic dermatitis
- Allergic contact dermatitis*
- Irritant or allergic contact urticaria
- Dermographism
- Folliculitis
Potential vulval allergens include:
- Methylisothiazolinone, a preservative in moist wipes
- Various textile dyes in underwear
- Fragrance in a douche or antiperspirant
- Rubber accelerants in condom, menstrual cup or underwear
- Latex rubber and semen are potential causes of contact urticaria.
Itch due to neoplasia
Benign and malignant neoplastic disorders of the vulva are often asymptomatic in their early stages, but they can cause itch. The most common cancerous lesions are:
- Squamous intraepithelial lesions (SIL, also known as vulval intraepithelial neoplasia or VIN)
- Extramammary Paget disease
- Invasive vulval cancer (squamous cell carcinoma)
Itch due to neuropathy
Which of the following condition is most likely to be associated with vaginal pH of 4 :
| A |
Atrophic vaginitis |
|
| B |
Trichomonas vaginitis |
|
| C |
Candidal vaginitis |
|
| D |
Gardenella vaginitis |
Ans. is C i.e. Candidal Vaginitis
- Candida albicans is a gram-positive yeast-like microorganism and grows well in acidic medium.
- Vaginal pH remains normal (4.0-4.5) in candida infection whereas pH above 4.5 should suggest the possibility of Other bacterial vaginosis (BV), trichomoniasis or mixed infections.
| A |
Gardnerella |
|
| B |
Trichomonas vaginalis |
|
| C |
Candida |
|
| D |
Gonococci |
Ans. is C. i.e. Candida
- The most common etiologies in adults resulting in symptoms of vaginitis include Candida albicans, Trichomonas vaginalis, and bacterial vaginosis.
- Candidiasis is a fungal infection common in women of childbearing age that results in pruritus, with a thick, white vaginal discharge.
- Patients often have a history of recurrent yeast infections or recent antibiotic treatment.
- Symptoms of candidiasis often begin just before menses.
- Precipitating factors include immunosuppression, diabetes mellitus, pregnancy, and hormone replacement therapy.
- Candidiasis is usually not contracted from a sexual partner.
- Seventy-five percent of all women have one episode of candidiasis in their lifetime.
- Recurrent episodes may indicate underlying immunodeficiency or diabetes.
- Trichomoniasis is associated with risk factors for other sexually transmitted diseases (STDs); elicit a history of multiple sexual partners.
- The discharge is usually copious, slightly green and frothy, resulting in local pain and irritation.
- Pruritus might be present. Symptoms often peak just after menses.
- Trichomonas vaginalis is the most common nonviral STD in the world.
- Infection during pregnancy has been associated with preterm deliveries and low birth weight infants.
- Bacterial/ Gardnerella vaginosis is asymptomatic in up to 50% of women.
- If a discharge is present, it is typically a homogeneous grayish-white or yellowish-white.
- Bacterial vaginosis is common in pregnant women and is associated with preterm birth.
- Treating pregnant women that have a history of preterm birth with symptomatic bacterial vaginosis early in pregnancy has been shown to decrease the incidence of preterm birth.
| A |
Candidiasis. |
|
| B |
HIV. |
|
| C |
Bacterial vaginosis. |
|
| D |
Syphilis. |
Ans. is A. Candidiasis
- The infection in the vagina as shown in the photograph above represents candidiasis as it shows the presence of white, thick, curd-like discharge.
- Candidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates.
- It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics, and corticosteroids.
- It is also seen in patients with diabetes. It causes a profuse discharge and intense pruritus with soreness of vagina and dysuria.
- Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identified.
- A 10% KOH smear shows the buds and hyphae of the Candida organism.
- Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with the cream of the same medication for external use.
