Vaginal candidiasis: symptoms, causes, diagnosis and treatment

What is vaginal candidiasis

Vaginal or vaginal candidiasis is an inflammatory disease when the mucous membrane of a woman’s vagina becomes inflamed.
As a rule, this disease is caused by the presence of yeast-like candida fungi (Latin “Candida albicans”). The type of fungus itself is harmless. The disease is popularly called thrush. It is an extremely common condition that affects women all over the world. A fungus of the genus Candida gets onto a person’s skin and mucous membranes at the time of birth, during the passage of the child through the birth canal. Consequently, this fungus remains our companion throughout our lives. In low concentrations, the fungus does not cause any harm. However, candida manifests its pathogenicity only when immunity decreases.

Symptoms of vaginal candidiasis

As a rule, women with candidiasis complain of curdled, white, sometimes sticky vaginal discharge. The most common symptom is itching (colpitis), which intensifies during long walking and running, during the menstrual cycle. There are also unpleasant pain sensations during sexual intercourse and when urinating. More than 30% of patients experience redness of the external genitalia. Despite the fact that thrush is most often transmitted sexually, the World Health Organization does not list this as the main cause of the disease.

The disease occurs over a long period of time. It may be accompanied by exacerbations and latent asymptomatic conditions. Our clinic provides fast and effective medical care. Qualified doctors prescribe the most optimal course of treatment for patients.

What is vaginal candidiasis? Causes of the disease

Vaginal candidiasis is an inflammatory disease of the genitourinary tract caused by yeast-like fungi of the genus Candida.

In most cases, the cause of vaginal candidiasis is Candida Albicans. It can reproduce successfully in an oxygen-free environment and grows especially well on tissues that contain large amounts of glycogen, including the mucous membrane of the female genitalia. Recently, doctors are increasingly discovering other pathogens of the Candida genus, but the overall frequency of their occurrence does not exceed 15-30%.

Internal risk factors for the development of vaginal candidiasis include endocrine diseases (diabetes mellitus, obesity, thyroid pathology, etc.), underlying gynecological diseases, disorders of local immunity; to external risk factors - taking antibacterial, glucocorticosteroid, cytostatic drugs, immunosuppressants, radiation therapy; wearing tight clothing, underwear made of synthetic fabrics, regular use of sanitary pads, prolonged use of intrauterine devices, vaginal diaphragms, douching, use of spermicides.

Risk factors

Factors that increase your risk of developing a yeast infection include:

Antibiotic therapy. Candidiasis is common among women taking antibacterial medications. Broad-spectrum antibiotics, which kill a number of bacteria, also destroy the normal microflora of the vagina, which leads to excessive growth of fungi.
Increased estrogen levels. Yeast infections are more common among women with elevated concentrations of female hormones. This may be seen in pregnant women taking birth control pills or receiving estrogen hormone therapy.
Uncontrolled diabetes mellitus. Women with diabetes who have poor blood sugar control are at greater risk of developing candidiasis than women who exercise self-control.
Weakened immunity. Women with immune systems weakened by corticosteroid therapy or HIV infection are more likely to develop candidiasis.
Sexual activity. Although candidiasis is not classified as a sexually transmitted infection, sexual contact can spread candida fungi.

Symptoms of vaginal candidiasis

Classic signs of vaginal candidiasis are:

itching and burning in the vagina and in the external genital area;
specific discharge resembling cottage cheese;
pain and burning when urinating;
discomfort and pain during sexual intercourse.

As a rule, discomfort intensifies in the afternoon, and in some women before menstruation. During a gynecological examination, the doctor detects swelling and redness of the mucous membrane of the genital tract, as well as specific white or yellowish-white cheesy thick vaginal discharge.

With a complicated course of the disease, cracks appear on the skin of the vulva and mucous membranes, posterior commissure and peranal area; with recurrent candidal vulvovaginitis, dryness, atrophy, lichenification in the affected area, and scanty whitish vaginal discharge are expressed.

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How is the fungus Candida albicans transmitted?

In terms of frequency of infection, candidiasis ranks 4th in the world and is classified as an autoimmune disease, in which the main cause of its occurrence lies in the human body itself. The sites of infection are the gastrointestinal tract, genitals, skin, nails, and nasopharynx. Penetrating into the body, the fungus attaches to the mucous membrane of the digestive system, then the bloodstream transfers it to other organs.

There are quite a few ways of infection with the fungus Candida Albicans, which poses a great danger given the speed of development of the fungus: it is capable of doubling its population in one hour. Interestingly, the fungus can enter the child’s body when it develops in the womb, passes through the birth canal, through breastfeeding, contact with the skin of an infected mother, or when playing with other people’s toys.

The fungus can enter the body of a healthy adult woman through:

kiss;
unprotected sex;
medical procedures (dental treatment, examination by a gynecologist, etc.);
airborne droplets;
hygiene items and clothing of an infected person;
stay in the pool, bathhouse, sauna.

Classification

There are several types of classification of vaginal candidiasis. Depending on the characteristics of the course, acute and chronic (recurrent) forms of the disease are distinguished. In the first case, the pathology is characterized by vivid symptoms and occurs no more than four times a year. With chronicity, the symptoms are usually less pronounced, and the disease itself recurs 4 times a year or more often.

Depending on the presence of complications, uncomplicated and complicated vaginal candidiasis is distinguished. In the first case, the process is relatively easy and can be stopped quite quickly with the selection of adequate therapy. As a rule, it occurs in women who do not have additional risk factors (diabetes mellitus, immunodeficiency states of various origins).

The complicated form of vaginal candidiasis is characterized by pronounced symptoms that negatively affect the patient’s daily life. As a rule, inflammation spreads to the external genitalia, causing the appearance of ulcers and cracks. This form often recurs.

Localization of the pathological process allows us to distinguish three forms of the disease:

vaginitis: inflammation affects only the vaginal mucosa;
vulvovaginitis: the external genitalia and vagina are affected;
cervicitis: the cervix is involved in the process.

Complications

Most complications of vaginal candidiasis are associated with the spread of the inflammatory process to nearby organs and tissues and the addition of bacterial inflammation. It occurs against the background of a sharp decrease in local immunity. Most often, patients encounter the following problems:

salpingitis and salpingo-oophoritis (adnexitis): inflammation of the uterine appendages: tubes and ovaries; the process can be unilateral or bilateral, accompanied by pain in the lower abdomen, weakness, fever; without treatment, it can cause infertility due to the development of adhesions;
urethritis: inflammation of the urethra; classic symptoms are a burning sensation when urinating, changes in the appearance and color of urine, redness and swelling in the area of the external urethral meatus;
cystitis: inflammation of the bladder that develops as a result of the passage of the pathogen from the urethra; Symptoms of urethritis include frequent urination with a small amount of urine, pain and cramping at the end of the process, increased temperature and pain in the lower abdomen.

In addition to the spread of infection, vaginal candidiasis can threaten the development of stenosis (narrowing) of the vagina. This condition occurs due to chronic inflammation, which leads to the growth of scar tissue and narrowing of the lumen of the organ. This leads to significant difficulty in sexual life.

Vaginal candidiasis is very dangerous for pregnant women, since without treatment, infection of the fetus is possible, which can lead to its death.

In the postpartum period, women may develop candidal endometritis.

Diagnostics

Diagnosis of vaginal candidiasis begins with collecting complaints. The gynecologist clarifies what worries the patient, when and under what circumstances specific problems appeared, as well as what measures were taken to eliminate them and with what effect. Attention is paid to the medical history: previous diseases (inflammation of the urogenital tract, STDs are especially important), the number of pregnancies and births, the number of sexual partners, etc.

The next diagnostic stage is an examination in a gynecological chair, during which the doctor identifies characteristic changes: swelling, redness, discharge and plaque. When Lugol's solution is applied to tissues, white dots resembling semolina are visualized on them, which is a characteristic sign of the disease. To confirm the diagnosis, the doctor prescribes:

microscopy of vaginal smears (during the process, spores and fungal cells are identified);
culture of vaginal discharge;
PCR and ELISA of the excreted to detect pathogen antigens;
blood test: general (signs of an inflammatory process are detected), tests to detect antibodies to Candida - remove!

If necessary (for example, during a recurrent course of the disease), tests are carried out to identify risk factors: elevated blood glucose levels, immunodeficiency, etc.

Interpretation of results

If there are clear signs of candidiasis (thrush), and during a laboratory test blastospores and pseudomycelia of the fungus were identified, the study ends here. A diagnosis is made and treatment begins.

If a microscopic examination gives a negative result, this does not indicate the absence of infection. The disease can occur in a latent chronic form. It is necessary to carry out a number of other tests, for example, microscopic examination of scrapings, determination of Candida DNA in scrapings, urine, and prostate secretions. Also prescribed:

Clinical blood test.
Test for HIV infection.
Determination of trace element reserves in the body.
Test for glucose and carbohydrate metabolism metabolites.

These laboratory tests can help identify conditions that may be causing the fungus to grow.

Treatment of vaginal candidiasis

Specific treatment aimed at eliminating vaginal candidiasis is carried out only after identifying the pathogen and if the patient has signs of the disease. The basis of therapy is specific antifungal agents: nystatin, clotrimazole, ketoconazole, fluconazole, nitrofungin and others. The specific drug, its dose, frequency of administration and course duration are selected individually depending on the characteristics of the course of the disease, the presence of concomitant pathologies and other factors.

If we are talking about an acute uncomplicated process, the drugs are prescribed in local form in the form of suppositories, vaginal tablets or creams. They are introduced directly into the genital tract, where they stop the active reproduction of the pathogen.

In the presence of complications, as well as in the chronic course of the disease, systemic drugs are used in the form of tablets for oral administration. The application regimen is selected on an individual basis.

Until the manifestations of vaginal candidiasis are completely eliminated, it is necessary to maintain sexual rest in order to minimize injury to the inflamed walls of the genital tract. In chronic cases, condoms must be used. The effectiveness of therapy is assessed 14 days after the start of treatment.

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Prognosis and prevention

To completely cure vaginal candidiasis, it is necessary to both consult a doctor in a timely manner and follow all his recommendations. Antifungal drugs are sold in pharmacies without a prescription, but DIY in this case is not only ineffective, but also dangerous. Only a specialist can correctly select the necessary medications, determine the characteristics of their use, and also monitor the effect of the medications.

It is important to understand that it is much easier to prevent vaginal candidiasis than to treat it. To minimize the risk of developing the disease, you must adhere to the following rules:

give preference to cotton underwear;
stop using panty liners;
use specialized products for genital hygiene;
do not use douching without a doctor’s prescription;
monitor the condition of the body, promptly treat pathologies of the genitourinary and digestive systems, endocrine glands;
avoid casual sex and infection with sexually transmitted diseases;
do not use antibiotics without a doctor’s prescription and do not change the dose and regimen without permission;
if long-term antibiotic therapy is necessary, take antifungal agents.

Vaginal candidiasis is an unpleasant disease that can be prevented and, if necessary, quickly cured. The main thing is to consult a doctor in a timely manner and follow all his recommendations.

Bibliography

Gynecology textbook. IV edition ed. Academician of the Russian Academy of Medical Sciences, Professor G.M. Savelyeva; prof. V.G. Breusenko 2012
Urogenital candidiasis. Clinical recommendations. Moscow, 2016 – 22 p.
Vulvovaginal candidiasis: pathogenesis, diagnosis and treatment tactics. Bayramova G.R., Amirkhanyan A.S., Chernova V.F. //Doctor.Ru 2018. No. 10 (154). pp. 32-36
Sherry L., Kean R., McKloud E., O'Donnell LE, Metcalfe R., Jones BL et al. Biofilms formed by isolates from recurrent vulvovaginal candidiasis patients are heterogeneous and insensitive to fluconazole. Antimicrob. Agents. Chemother. 2017; 61(9): e01065-17
Prilepskaya V.N. Vulvovaginal candidiasis. Clinic, diagnosis, principles of therapy: manual / V.N. Prilepskaya, G.R. Bayramova - M 2008 - 50s
Atlas of pathogens of fungal infections/E.N. Moskvitina and others - Moscow GEOTAR-Media, 2021 208p
Zordan R., Cormack B. Adgesis on opportunistic fungal pathogens In: Calderone RA, Clancy CJ, ed Candada and candidiasis/ Washington: ASM press; 2012: 243-259)
Zhang Y., Li W., Chu M., Chen H., Yu H., Fang C. et al. The AAA AT Pase Vps4 plays important roles in Candida albicans hyphal formation and is inhibited by DBeQ. Mycopathology 2016; (5-6) 329-39
Murciano C., Moyes DL, Runglall M., Yobouti P., Islam A., Hoyer LL et al. Evaluation of the role of Candida albicans agglutinin-like sequence (Als) proteins in human oral epithelial cell interactions. Plos one 2012.
Center for Disease Control (CDC) Sexually Transmitted Disease Treatment Guidelines, 2015.
Donders GG, Bellen G., Mendling W. Management of recurrent vulvovaginal candidosis as a chronic illness. Gynecol. Obstet. Invest 2010 70(4):306-21
Ankirskaya A.S. Muravyova V.V. Microbiological characteristics of vaginal infections caused by fungi of the genus Candida // sexually transmitted diseases 2001. pp. 12-14
Eschenbach DA Chronic vulvovaginal candidosis N Engl. J Med 2004; 351(9)
Tikhomirov A.L. Oleinik Ch.G. Optimization of treatment of recurrent vulvovaginal candidiasis // effective therapy in obstetrics and gynecology. 2007 No. 3 from 22-27
Bayramova G.R. Recurrent vaginal candidiasis. Clinic, diagnosis, treatment. dis. Doctor of Medical Sciences M. 2013 (46s)
Prilepskaya V.N. Bayramova G.R. Vulvovaginal candidiasis, modern ways to solve the problem. Difficult patient 2006 (from 33-36)

Sources

Denison HJ., Worswick J., Bond CM., Grimshaw JM., Mayhew A., Gnani Ramadoss S., Robertson C., Schaafsma ME., Watson MC. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). // Cochrane Database Syst Rev - 2021 - Vol8 - NNULL - p.CD002845; PMID:32845024
Yeh SJ., Yeh CC., Lan CY., Chen BS. Investigating Common Pathogenic Mechanisms between Homo sapiens and Different Strains of Candida albicans for Drug Design: Systems Biology Approach via Two-Sided NGS Data Identification. // Toxins (Basel) - 2021 - Vol11 - N2 - p.; PMID:30769958
Tulasidas S., Rao P., Bhat S., Manipura R. A study on biofilm production and antifungal drug resistance among Candida species from vulvovaginal and bloodstream infections. // Infect Drug Resist - 2021 - Vol11 - NNULL - p.2443-2448; PMID:30538510
St Clair-Brown TT., Schwerer KE., Dogbey GY. Neonatal Thrush Is Not Associated with Mode of Delivery. // J Am Board Fam Med - 2019 - Vol31 - N4 - p.537-541; PMID:29986979
Pidwill GR., Rego S., Jenkinson HF., Lamont RJ., Nobbs AH. Coassociation between Group B Streptococcus and Candida albicans Promotes Interactions with Vaginal Epithelium. // Infect Immun - 2018 - Vol86 - N4 - p.; PMID:29339458
Gow NAR., Yadav B. Microbe Profile: Candida albicans: a shape-changing, opportunistic pathogenic fungus of humans. // Microbiology (Reading) - 2021 - Vol163 - N8 - p.1145-1147; PMID:28809155
Gamaletsou MN., Drogari-Apiranthitou M., Denning DW., Sipsas NV. An estimate of the burden of serious fungal diseases in Greece. // Eur J Clin Microbiol Infect Dis - 2021 - Vol35 - N7 - p.1115-20; PMID:27086365
Osmanov A., Denning DW. Burden of serious fungal infections in Ukraine. // Mycoses - 2015 - Vol58 Suppl 5 - NNULL - p.94-100; PMID:26449513