With women of reproductive age, vulvovaginal candidiasis (VVC) is common. About 75% of women will at some time in their life have symptomatic VVC.
Etiology For 80–92% of VVC instances, Candida albicans is to blame. The species C. glabrata, C. tropicalis, and C. krusei are responsible for the remaining occurrences.
If symptoms are absent, isolation of candida is not required because 10–20% of women have vaginal colonisation with Candida species.
Not a STI, that is.
Because it is associated with vaginal oestrogen consumption, symptomatic VVC is uncommon before menarche and after menopause but common throughout reproductive years and pregnancy.
Predisposing host factors include vulval irritation/trauma, diabetes, immunosuppression, antibiotics (which alter vaginal flora and promote yeast carriage).
Though it can be more challenging to manage in situations of pregnancy, recurrent episodes, non-albicans species, or abnormal host factors (such diabetes), VVC is usually easy to treat.
Symptoms and signs
Symptoms include vaginal discharge, superficial dyspareunia, external dysuria, and discomfort or pain.
Symptoms include oedema, fissuring, satellite lesions, excoriation, discharge, and vulval erythema (vulvovaginitis).
Vaginal discharge affects half of women with VVC. Usually curdly, it is not objectionable. Looked examined closely, it leaves white plaques on the vaginal walls.
Diagnosis
In non-specialist settings, women are frequently treated empirically according to their past. It is advised to do a full examination and investigation if symptoms continue or come back. It is possible to distinguish VVC from other diseases by measuring the vaginal pH. Between 4.0 and 4.5 is the typical pH of the vagina.
Microscopy
One can get a sample of the lateral vaginal wall by wet mount or Gram staining.
In 65% of women with candidiasis, a Gram stain seen under a microscope can show pseudohyphae and spores.
In symptomatic women, wet mount slides (saline microscopy) have a 40–60% sensitivity for vaginal discharge.
Culture
For the diagnosis of candidiasis, this is still the gold standard.
When microscopy is unclear or determining the species type is important, like in the case of recurrent VVC, this technique works well.
Species can be transported to the laboratory in a transport medium (e.g., HVS) for delayed inoculation, or they can be plated straight on culture media (e.g., Sabouraud’s).
Culture is over 99% specific and 70–80% sensitive.
Management
General
General genital hygiene advice for VVC sufferers:
Away from local irritants like scented soaps and wipes.
Shampoo can be replaced with an emollient.
Dress loosely fitting and with cotton underwear.
Treatments
There is over 80% cure rate with both oral and intravaginal azole treatments.
One extensive list is available in the British National Formulary (BNF).
Choice of preparations will be determined by availability, pricing, and personal preference.
Though there is less research to back up their efficacy, topical medicines can be utilized in conjunction with oral or intravaginal therapies for women who are experiencing vulval discomfort. They might also provoke a stinging reaction locally.
Follow-up and PIN
Should symptoms go away, no more tests for cure or follow-up are needed. Whether episodic or recurrent, women with VVC should not screen or treat their asymptomatic sexual partners.
V VC in pregnancy
Pregnancy is the common time for symptomatic VVC.
Asymptomatic Candida colonization increases to 30–40% during pregnancy.
Unfavorable pregnancy outcomes are unrelated.
Treatment for symptomatic VVC is indicated to be topical imidazoles, including clotrimazole. Sometimes longer treatment plans—seven days, for example—are needed.
Uncertain teratogenic consequences make oral treatments unwise.
Recurrent V VC
Symptomatic VVC occurring four times or more in a 12-month period, at least two of which have been validated mycologically.
Recurrent VVC occurs in about 5% of women who have their first episode.
Usually brought on by species other than C. albicans.
Although its Aetiology is unknown, host factors like immunosuppression, poorly managed diabetes, and broad-spectrum antibiotic use could be involved.
Contraception: Although COCs and VVC have been associated in the past, more recent combination methods use low doses of estrogen and offer no strong proof of raising the risk. Recurrent disease associated to relative hypoestrogenism may be reduced by injectable progestogens.
Considering the history of the patient, think about doing a random blood glucose test. Ask for a speciation- and sensitivity-based culture to rule out non-albicans species.
Management: The usual guidelines for a main episode should apply here as well.
Recommended is a six-month induction and maintenance program . Ninety percent of women remain disease-free during treatment, although after a year this drops to forty percent.
Few studies support the use of tea tree oil, dietary changes, or oral or vaginal lactobacillus as preventive measures against VVC.
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