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In this
article I’ll be posting all about the causative organism, risk factors,
symptoms, diagnosis and treatment of vulvovaginal
candidiasis.
In developing countries like India, a lot of women suffer from candida infection, also called as the “yeast infection”.
The disease spectrum ranges from ―innocent bystander,where symptoms are wrongly attributed to coincidental isolation of candida to complicated disease where Vulvovaginal Candidiasis is severe, persistent, or recurrent or there is an underlying host abnormality [1].
Vulvovaginal
candidiasis (VVC) has been associated with considerable direct and indirect
economic costs [2], enhanced susceptibility to HIV infection [3], and is being
investigated for a potential relationship with preterm birth [4]. Short-course
azole-based treatment regimens are considered effective and safe [5] and are
accessible and affordable in most settings.
Much
of the epidemiologic literature concerning vulvovaginal candidiasis reports on
studies in which women were queried on their self-reported history of it [6].
The lack of representative data on the epidemiologic features of
laboratory-confirmed vulvovaginal candidiasis has been evident throughout the
time in which it has evolved from being considered a ―nuisance infection to a
clinically relevant condition [7, 8].
What is the causative organism?
The causative
organism is a fungus named Candida albicans. Some can be
caused by other Candida spp.
Candida
albicans is a part of normal skin
flora.
What are the risk factors that make you more prone to
candida infection?
There are
various conditions which makes an individual more prone to this yeast infection
such as-
1.
Diabetes
2.
Steroid therapy
3.
Antibiotics
4.
Pregnancy
5.
Obesity
6.
Oral contraceptive pills
7.
Human immunodeficiency
virus (HIV) infection
8.
Immunosuppressant drugs.
9.
Malnutrition
According
to researches approximately ten to twenty percentages of women have candida colonized
in the vagina.
What are the symptoms associated with vaginal candidiasis?
The major
symptoms associated with vulvo-vaginal candidiasis are-
· Dyspareunia (painful sexual
intercourse)
·
Vulvar pruritis (itching)
·
Vulvovaginal soreness
·
External dysuria (painful
or difficulty in urination)
·
Thick or “cheesy” vaginal
secretions.
If you
experience any of the symptoms visit your gynecologist for the same.
What is the normal vaginal ph?
The normal
vaginal pH is 4.5, that is towards the acidic side.
How is Candidiasis
diagnosed?
1. Your doctor will perform a
per speculum examination
which will reveal candidal plaques adhered to the vaginal mucosa with redness
and swelling in the introitus.
2. The most easiest and cost
effective method of diagnosis is the examination of fungal hyphae or pseudohyphae
in a KOH preparation.
3. Microbiological cultures are obtained in patients who are symptomatic but shows
negative KOH testing.
4.
Another way of diagnosis is
a PAP smear. It is taken using an
ayres spatula and sent for PAP smear (cytological) examination in the pathology
lab for diagnosing the fungus under the microscope.
Even if
you get negative results with KOH preparation the PAP smear examination and
microbiological cultures reveal the candida spores and hyphae and then treatment
is given to the patient.
Microscopy
should be of either a Gram stained or wet mount preparation [9,10,11].
Microscopic appearance-
Candida
appears as multiple fungal spores, septate hyphae and pseudohyphae on
microscopic examination.
What treatment is given to the affected patients?
·
Antifungal drugs in form of
tablets and cream or suppository are given to the patients.
· The recurrent episodes of
candidiasis generally respond to the topical treatment, but longer treatment
may be indicated in some patients.
So, this
was all about vulvo-vaginal candidiasis.
Hope you
found it useful.
Take care.🥰
Stay safe.
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For Q&A on Cervical Cancer Screening click https://www.themicroscopicsight.com/2020/05/cervical-cancer-screening-q.html
References
[1].
Sobel J D, Faro S, Force R W. Et Al Vulvovaginal Candidiasis: Epidemiologic,
Diagnostic, And Therapeutic Considerations. Am J Obstet Gynecol
1998178203–211.211 [Pubmed]
[2].
Foxman B, Barlow R, D’arcy H, Gillespie B, Sobel Jd. Candida Vaginitis:
Self-Reported Incidence And Associated Costs. Sexually Transmitted Diseases.
2000;27(4):230–235. [Pubmed]
[3].
Røttingen Ja, Cameron Wd, Garnett Gp. A Systematic Review Of The Epidemiologic
Interactions Between Classic Sexually Transmitted Diseases And Hiv: How Much
Really Is Known? Sexually Transmitted Diseases.2001;28(10):579–597. [Pubmed]
[4].
Roberts Cl, Morris Jm, Rickard Kr, Et Al. Protocol For A Randomised Controlled
Trial Of Treatment Of Asymptomatic Candidiasis For The Prevention Of Preterm Birth
[Actrn12610000607077] Bmc Pregnancy And Childbirth. 2011;11, Article 19 [Pmc
Free Article] [Pubmed]
[5].
Sobel Jd. Vulvovaginal Candidosis. Lancet. 2007;369(9577):1961–1971. [Pubmed]
[6].
Geiger Am, Foxman B, Gillespie Bw. The Epidemiology Of Vulvovaginal Candidiasis
Among University Students. American Journal Of Public Health.
1995;85(8):1146–1148. [Pmc Free Article] [Pubmed]
[7].
Kent Hl. Epidemiology Of Vaginitis. American Journal Of Obstetrics &
Gynecology. 1991;165(4):1168–1176. [Pubmed]
[8].
Marrazzo J. Vulvovaginal Candidiasis. British Medical Journal.
2003;326(7397):993–994.[Pmc Free Article] [Pubmed]
[9]. Zdolsek B, Hellberg D, Froman G. Et Al
Culture And Wet Smear Microscopy In The Diagnosis Of Low‐Symptomatic Vulvovaginal Candidosis. Eur J Obstet
Gynecol Reproduct Biol 19955847–51.51 [Pubmed]
[10].
Sonnex C, Lefort W. Microscopic Features Of Vaginal Candidiasis And Their
Relation To Symptomatology. Sex Transm Infect 199975417–419.419 [Pmc Free
Article] [Pubmed]
[11].
Schaaf V M, Perez‐Stable E J, Borchardt K. The Limited Value Of Symptoms
And Signs In The Diagnosis Of Vaginal Infections. Arch Intern Med
19901501929–1933.1933 [Pubmed]
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