| Candidal vulvovaginitis | |
|---|---|
| Classification and external resources | |
| ICD-10 | B37.3, N77.1 |
| ICD-9 | 112.1, 616.1 |
| MeSH | D002181 |
Candidal vulvovaginitis is an infection of the vagina’s mucous membranes by Candida albicans.[1] Up to 75% of women will have thrush at some point in their lives, and approximately 5% will have recurring episodes.[2]
Contents |
Candidal vulvovaginitis, or vaginal thrush is most commonly caused by a type of fungus 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.
The symptoms of vaginal thrush include vulval itching, vulval soreness and irritation, pain or discomfort during sexual intercourse (superficial dyspareunia), 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.
As well as the above symptoms of thrush, vulvovaginal inflammation can also be present. The signs of vulvovaginal inflammation include erythema (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).[3]
Thrush may be described as being uncomplicated or complicated.
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 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 pregnancy, poorly controlled diabetes, an immune deficiency, or the thrush is not caused by the Candida albicans fungus.[3]
Following are alternatives of recommended regimens, according to the CDC guidelines 2006.[4] The * denotes drugs that are available over-the-counter. 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.[4]
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.[4]
Circumcised males will usually not have to go through treatment unless inflammation of the glans penis is present.[2]
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 vaginosis (the most common cause of abnormal vaginal discharge), rather than thrush.[3]
Certain factors increase the risk of developing vagina thrush.
Thrush most commonly affects women in their twenties and thirties. Thrush is less common in girls who have not yet started their periods, and women who have started the menopause.
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 bacteria. 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.
In pregnancy, changes in the levels of female sex hormones, such as estrogen, 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 is usually controlled through insulin injections or through diet and if poorly controlled, diabetes can cause vaginal thrush to develop.[3]
The risk of developing thrush is also increased in a weakened immune system,[3] for example, by an immunosuppressive condition, such as HIV 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.
It is not thought that oral contraceptives increase the risk of thrush.
Candidal organisms do not appear to be transmitted sexually, and episodes of vulvovaginal candidiasis do not appear to be related to the number of sexual partners.[2]
Wearing tight-fitting clothing, such as tights and thong underwear, may increase the risk of developing thrush.
There is little evidence to suggest that sanitary towels are a risk factor for thrush. There is also no evidence that tampons or vaginal douching are risk factors.[3]
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