Candidal vulvovaginitis
Encyclopedia
Candidal vulvovaginitis is an infection of the vagina’s mucous membrane
s by Candida albicans
. Up to 75% of women will have thrush at some point in their lives, and approximately 5% will have recurring episodes.
known as Candida albicans
. The Candida species of fungus is found naturally in the vagina, and is usually harmless. However, if the conditions in the vagina change, Candida albicans can cause the symptoms of thrush.
It is not known exactly how changes in the vagina trigger thrush, but it may be due to a hormone (chemical) imbalance. In most cases, the cause of the hormonal changes is unknown. Some possible risk factors have been identified, such as taking antibiotics.
), pain or discomfort during urination (dysuria
) and vaginal discharge, which is usually odourless. This can be thin and watery, or thick and white, like cottage cheese.
(redness) of the vagina and vulva, vagina fissuring (cracked skin), oedema (swelling from a build-up of fluid), also in severe cases, satellite lesions (sores in the surrounding area). This is rare, but may indicate the presence of another fungal condition, or the herpes simplex virus
(the virus that causes genital herpes).
, poorly controlled diabetes, an immune deficiency, or the thrush is not caused by the Candida albicans fungus.
Intravaginal` Agents:
Oral Agent:
Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated candidal vulvovaginitis. The
topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy.
The creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms. Refer to
condom product labeling for further information. Intravaginal preparations of butaconazole, clotrimazole,
miconazole, and tioconazole are available over-the-counter (OTC). Women whose condition has previously been diagnosed
with candidal vulvovaginitis are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an OTC preparation, or who has a recurrence of symptoms within 2 months, should be evaluated with office-based testing. Unnecessary or inappropriate use of OTC preparations is common and can lead to a delay in the treatment
of other vulvovaginitis etiologies, which can result in adverse clinical outcomes.
Circumcised males will usually not have to go through treatment unless inflammation of the glans penis
is present.
(the most common cause of abnormal vaginal discharge), rather than thrush.
, and women who have started the menopause
.
. They can either be taken orally or inserted into the vagina. Any type of antibiotics can increase the risk of developing thrush, but in order to develop the condition, the Candida fungus must already be present.
, make a woman more likely to develop thrush. During pregnancy, the Candida fungus is more prevalent (common), and recurrent infection is also more likely.
is usually controlled through insulin
injections or through diet and if poorly controlled, diabetes can cause vaginal thrush to develop.
or AIDS
, or receiving chemotherapy
. This is because in these circumstances the body's immune system, which usually fights off infection
, is unable to effectively control the spread of the Candida fungus.
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
s by Candida albicans
Candida albicans
Candida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
. Up to 75% of women will have thrush at some point in their lives, and approximately 5% will have recurring episodes.
Cause and pathophysiology
Candidal vulvovaginitis, or vaginal thrush is most commonly caused by a type of fungusFungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...
known as Candida albicans
Candida albicans
Candida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
. The Candida species of fungus is found naturally in the vagina, and is usually harmless. However, if the conditions in the vagina change, Candida albicans can cause the symptoms of thrush.
It is not known exactly how changes in the vagina trigger thrush, but it may be due to a hormone (chemical) imbalance. In most cases, the cause of the hormonal changes is unknown. Some possible risk factors have been identified, such as taking antibiotics.
Symptoms
The symptoms of vaginal thrush include vulval itching, vulval soreness and irritation, pain or discomfort during sexual intercourse (superficial dyspareuniaDyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
), pain or discomfort during urination (dysuria
Dysuria
In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
) and vaginal discharge, which is usually odourless. This can be thin and watery, or thick and white, like cottage cheese.
Vulvovaginal inflammation
As well as the above symptoms of thrush, vulvovaginal inflammation can also be present. The signs of vulvovaginal inflammation include erythemaErythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
(redness) of the vagina and vulva, vagina fissuring (cracked skin), oedema (swelling from a build-up of fluid), also in severe cases, satellite lesions (sores in the surrounding area). This is rare, but may indicate the presence of another fungal condition, or the herpes simplex virus
Herpes simplex virus
Herpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
(the virus that causes genital herpes).
Uncomplicated thrush
Uncomplicated thrush is where only a single episode of thrush or less than four episodes occurs in a year. Thrush is described as uncomplicated if the symptoms are mild or moderate, and caused by the Candida albicans fungus.Complicated thrush
Complicated thrush is four or more episodes of thrush are present in a year or when severe symptoms of vulvovaginal inflammation are experienced. Thrush may also be described as complicated if coupled with pregnancyPregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, poorly controlled diabetes, an immune deficiency, or the thrush is not caused by the Candida albicans fungus.
Treatment
Following are alternatives of recommended regimens, according to the CDC guidelines 2006. The * denotes drugs that are available over-the-counter.Intravaginal` Agents:
- ButoconazoleButoconazoleButoconazole is an imidazole antifungal used in gynecology....
, only one dose of cream is required.- 2% cream 5 g in the vagina for 3 days*
- 2% cream 5 g (Butaconazole1-sustained release), single application in the vagina
- ClotrimazoleClotrimazoleClotrimazole is an antifungal medication commonly used in the treatment of fungal infections such as vaginal yeast infections, oral thrush, and ringworm...
- 1% cream 5 g in the vagina for 7–14 days*, given twice a day, in the morning and evening
- 100 mg vagina tablet at night before sleep for 7 days
- Clotrimazole 100 mg vaginal tablet, two tablets (at bedtime) for 3 days
- MiconazoleMiconazoleMiconazole is an imidazole antifungal agent, developed by Janssen Pharmaceutica, commonly applied topically to the skin or to mucus membranes to cure fungal infections. It works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes...
- 2% cream 5 g in the vagina for 7 days*
- 100 mg vagina suppository, one suppository for 7 days*
- 200 mg vagina suppository, one suppository for 3 days*
- 1,200 mg vagina suppository, one suppository for 1 day*
- NystatinNystatinNystatin is a polyene antifungal medication to which many molds and yeast infections are sensitive, including Candida. Due to its toxicity profile, there are currently no injectable formulations of this drug on the US market...
100,000-unit vaginal tablet, one (or two) tablet(s) a day for 14 days - TioconazoleTioconazoleTioconazole is an antifungal medication of the imidazole class used to treat infections caused by a fungus or yeast. It is marketed under the brand names. Tioconazole ointments serve to treat women's vaginal yeast infections...
6.5% ointment 5 g in the vagina in a single application* - TerconazoleTerconazoleTerconazole is an anti-fungal medication, primarily used to treat vaginal fungal infections.-References:*...
- 0.4% cream 5 g in the vagina for 7 days
- 0.8% cream 5 g in the vagina for 3 days
- 80 mg vagina suppository, one suppository for 3 days
Oral Agent:
- FluconazoleFluconazoleFluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. In a bulk powder form, it appears as a white crystalline powder, and it is very slightly soluble in water and soluble in alcohol. It is commonly marketed under the trade...
150 mg oral tablet, one tablet in single dose
Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated candidal vulvovaginitis. The
topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy.
The creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms. Refer to
condom product labeling for further information. Intravaginal preparations of butaconazole, clotrimazole,
miconazole, and tioconazole are available over-the-counter (OTC). Women whose condition has previously been diagnosed
with candidal vulvovaginitis are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an OTC preparation, or who has a recurrence of symptoms within 2 months, should be evaluated with office-based testing. Unnecessary or inappropriate use of OTC preparations is common and can lead to a delay in the treatment
of other vulvovaginitis etiologies, which can result in adverse clinical outcomes.
Circumcised males will usually not have to go through treatment unless inflammation of the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
is present.
Treatment failure
Treatment for vagina thrush using [antifungal] medication is ineffective in up to 20% of cases. Treatment for thrush is considered to have failed if the symptoms do not clear within 7–14 days. There are a number of reasons for treatment failure. For example, if the infection is a different kind, such as bacterial vaginosisBacterial vaginosis
Bacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex...
(the most common cause of abnormal vaginal discharge), rather than thrush.
Risk of contracting candidal vulvovaginitis
Certain factors increase the risk of developing vagina thrush.Age
Thrush most commonly affects women in their twenties and thirties. Thrush is less common in girls who have not yet started their periodsMenstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
, and women who have started the menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
.
Antibiotics
Thrush occurs in about 30% of women who are taking a course of systemic, or intravaginal, antibiotics. These are medicines that treat infections caused by bacteriaBacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
. They can either be taken orally or inserted into the vagina. Any type of antibiotics can increase the risk of developing thrush, but in order to develop the condition, the Candida fungus must already be present.
Pregnancy
In pregnancy, changes in the levels of female sex hormones, such as estrogenEstrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
, make a woman more likely to develop thrush. During pregnancy, the Candida fungus is more prevalent (common), and recurrent infection is also more likely.
Diabetes (poorly controlled)
DiabetesDiabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
is usually controlled through insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
injections or through diet and if poorly controlled, diabetes can cause vaginal thrush to develop.
Immunodeficiency
The risk of developing thrush is also increased in a weakened immune system, for example, by an immunosuppressive condition, such as HIVHIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
or AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, or receiving chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
. This is because in these circumstances the body's immune system, which usually fights off infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, is unable to effectively control the spread of the Candida fungus.