What is Vaginal Candidiasis?
Vaginal candidiasis is one of the most common diseases of the vagina of infectious etiology and in recent years its frequency has increased. In the USA, 13 million cases of the disease are registered every year, which is 10% of the female population of the country. 3 out of 4 women of reproductive age at least 1 time suffered vaginal candidiasis.
Causes of Vaginal Candidiasis
The causative agent of the disease is yeast-like fungi of the genus Candida. Most often (95%) the vagina is affected by Candida albicans, less often – C. glabrata, C. tropicalis, S. krusei, etc. Candida fungi are unicellular aerobic microorganisms ranging in size from 1.5 to 10 microns round. For growth and reproduction of fungi the optimum temperature is 21-37 ° C and a weakly acidic medium.
Genital candidiasis does not belong to sexually transmitted diseases, but is often their marker. Fungi belong to the conditionally pathogenic flora that normally lives on the surface of the skin and mucous membranes, including the vagina. However, under certain conditions (decrease in general and local resistance, antibiotics, oral contraceptives, cytotoxic drugs and glucocorticosteroids, diabetes mellitus, tuberculosis, malignant neoplasms, chronic infections, etc.), it can cause disease. This increases the adhesive properties of fungi, which are attached to the vaginal epithelium cells, causing colonization of the mucous membrane and the development of an inflammatory reaction. Usually candidiasis affects only the superficial layers of the vaginal epithelium. In rare cases, the epithelial barrier is overcome and invasion of the pathogen into the underlying tissues with hematogenous dissemination occurs.
There is evidence that during the recurrence of urogenital candidiasis the main reservoir of infection is the intestine, from which fungi periodically enter the vagina, causing an exacerbation of the inflammatory process.
Infection of newborns with Candida fungi most often occurs intranatally.
Classification. There are acute (disease duration up to 2 months) and chronic (recurrent, disease duration more than 2 months) urogenital candidiasis.
Symptoms of Vaginal Candida
Vaginal candidiasis causes complaints of itching, burning in the vagina, cheesy discharge from the genital tract. Itching and burning sensation after water procedures, sexual intercourse or during sleep. Involvement of the urinary tract process leads to dysuric disorders.
Diagnosis of Vaginal Candida
Diagnosis of vaginal candidiasis is based on complaints, anamnesis (conditions for the occurrence of candidiasis) and gynecological findings. In the acute period of the disease, the skin of the external genital organs is secondarily involved in the inflammatory process. Vesicles are formed on the skin, they open and leave erosion. Examination of the vagina and the vaginal portion of the cervix with the help of mirrors reveals hyperemia, edema, white or gray-white cheesy overlay on the walls of the vagina. By colposcopic signs of vaginal candidiasis after dyeing with Lugol’s solution, there are punctate inclusions in the form of “semolina” with a pronounced vascular pattern. In chronic candidiasis, secondary elements of inflammation predominate – tissue infiltration, sclerotic and atrophic changes.
The most informative in the diagnostic plan is microbiological research. Microscopy of a native or Gram-colored vaginal smear can detect spores and fungus pseudomycelium. A good addition to microscopy is the culture method – sowing vaginal contents on artificial nutrient media (Saburo medium, 5% blood agar). Cultural research determines the species of fungi, as well as their sensitivity to antimycotic drugs.
Additional methods for vaginal candidiasis include studies of intestinal microbiocenosis, sexually transmitted infection tests, analysis of the glycemic profile with the load.
Treatment of Vaginal Candida
Treatment of vaginal candidiasis should be complex, not only with the impact on the causative agent, but also with the elimination of predisposing factors. Recommend refusal to take oral contraceptives, antibiotics, glucocorticosteroids, cytostatics, carry out medical correction of diabetes. During the period of treatment and. dispensary observation is recommended the use of condoms.
For the treatment of acute forms of urogenital candidiasis in the first stage, local treatment is usually applied:
- econazole 150 mg in vaginal suppositories 1 time per day for 3 days;
- isoconazole 600 mg in vaginal balls once before bedtime;
- serzhinan (combined drug) in vaginal tablets – 1 tablet daily before bedtime for 20 days;
- MacMiror complex (combined preparation) – 1 candle at bedtime for 8 days or a cream of 2-3 g using an applicator 1 time per day for 8 days.
Alternative schemes:
- fluconozol 150 mg orally once before bedtime;
- itraconazole 200 mg orally 2 times with an interval of 12 hours, only 2 times or 200 mg orally once a day for 3 days;
- clotrimazole in vaginal tablets 100 mg at bedtime for 6 days or 200 mg at bedtime for 3 days;
- natamycin in vaginal suppositories 1 time per day for 6-9 days;
- ciclopirox olamine, 1 candle at bedtime for 3-6 days or 2-3 g of cream with an applicator 1 time per day for 3-6 days.
In chronic urogenital candidiasis, along with local treatment, systemic drugs are used:
- fluconazole 150 mg orally once before bedtime;
- itraconazole 200 mg orally 2 times with an interval of 12 hours, only 2 times, or 200 mg orally 1 time per day for 3 days;
- ciclopirox olamine, 1 candle at bedtime for 6 days or 3 g of cream with an applicator 1 time per day for 3-6 days.
In addition to the main therapy, intravaginal administration of polyvinylpyrrolidone-iodine antiseptic is possible on 1 suppository (Betadine) 2 times a day for 7 days during the acute process and 1 candle before going to bed for 14 days for chronic.
In pregnant women, use local therapy for a period of not more than 7 days, preference is given to natamycin (“Pimafucin”).
Children use low-toxic drugs:
- fluconazole 1 – 2 mg per 1 kg once inside;
- Makmiror complex (combination drug), 1 candle at bedtime for 8 days or a cream of 2-3 g using an applicator 1 time per day for 8 days;
- ciclopirox olamine, 1 candle at bedtime for 3-6 days or 2-3 g of cream with an applicator 1 time per day for 3-6 days;
- serzhinan (combination drug) in adolescents in the form of vaginal tablets and 1/2 tablets daily before bedtime for 20 days.
Special nozzles on the tubes allow you to make applications of the cream, without damaging the hymen.
At the second stage of treatment, correction of the impaired microbiocenosis of the vagina is performed.
Criteria for cure are the resolution of clinical manifestations and the negative results of microbiological research. With treatment failure, it is necessary to repeat the course in other regimens.
Prevention of Vaginal Candida
Prevention of vaginal candidiasis is to eliminate the conditions for its occurrence.