Recurrence Vaginal Candidiasis

Candidiasis is a yeast infection and also known as fungal infection, called Candida. Candida is usually colonized inside the body such as the mouth,throat,gut, vagina and skin, which cause no problem. This candida multiplies and causes infection if the pH level imbalance in the vagina. Candidiasis which infects the vagina commonly called “ Vaginal candidiasis” or other names of “Vulvovaginal candidiasis”, “Candidal vaginitis” or “ Vaginal yeast infection”. 

Vaginal candidiasis is one of most common infections by female patients with an increase in trend. The estimation of this candidiasis infection is about 75% of all women will experience in their lifetime, about 50 % of them will experience a second episode and 5 % will have recurrence. Vaginal and cervical secretions act as a last line defense from an ascendent infection pathway spreading. This microbiota disturbs the vaginal ecosystem by factors which include endogenous, infectious, way of life and iatrogenic. 

Candida albicans is a common species which cause about 85-90% of vaginal candidiasis but other species such as Candida tropicalis, Candida glabrata, Candida particulary, Candida cruises and so on are commonly cause in vulvovaginal candidiasis. The non -albicans species are more resistant to fluconazole and antimycotics which is about 70%. There are several factors that predisposing in association with recurrence of vaginal candidiasis, those factors are the Candida genotypes, immunodeficiency status, the use of oral contraceptives, resistance and virulence, unregulated hyperglycemia and long term use of antibiotics.

Symptoms

  • White curd like or cottage cheese like vaginal discharge
  • Burning sensation of vaginal and vulva
  • Vaginal itchiness and soreness
  • Pain during urination
  • Itchy rash surrounding the vulva and pubic area and spread to thigh region

Who can get vaginal candidiasis?

  • Pregnancy (Higher percentage in gestational DM, multiple pregnancies and third trimester of pregnancy)
  • Way of life (inadequate hygiene, synthetic underwear)
  • Unprotected sex
  • Immunodeficiency (untreated HIV infection, AIDS, steroid dependant and chemotherapy)
  • Uncontrolled diabetic mellitus
  • Obesity
  • Higher dose of combined oral contraceptive pills
  • Prolong use of antibiotics or using broad- spectrum antibiotics
  • Iron deficiency anemia
  • Underlying skin conditions such as lichen planus or lichen sclerosus and vulva psoriasis.

Diagnosis and lab test

A diagnosis is made by inspection and recognizing the colonized appearance. Your physician will do pelvic examination, pH testing, vaginal wet mouth prep or high vaginal swab test for culture to confirm the diagnosis.

Treatment

  • Usually treated with antifungal medication.
  • For infectious, treatment will be antifungal pessary into vagina and/or one single oral antifungal medicine.
  • For complicated Candida vaginitis/immunosuppressed patients, oral antifungal may need to be consumed for 3 doses every 3 days and intravaginal pessary for at least 1 week.
  • Recurrence treatment: antifungal tablet for 3 days (day 1, day 4 and day 7) then every week one antifungal tablet for 6 months (Induction and maintenance therapy)

How to prevent vaginal candidiasis?

  • Wear loose cotton panties. Avoid synthetic or nylon panties.
  • Avoid bar soap, harsh detergent.
  • Wash the perineum from front to back and damp with clean towel.
  • Avoid feminime wash
  • Not to consume antifungal in prolonged periods. This can result in dermatitis or proliferation of non-albican infections.
  • Oral antifungal medication. Relapse can occur in 50% of women with recurrent vaginal candidiasis after the treatment, for those womens’ need a retreatment appropriately. Some require long term therapy.
  • Salt bath

Refer perineum care for better understanding.

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