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Vaginal Candidiasis – The Known Opportunistic Fiend
















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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 LowSymptomatic 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, PerezStable 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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