DefinitionThis section has been translated automatically.
Acute, chronic or chronically recurrent inflammatory infection of the vulva and/or the vagina caused by yeast fungi of the genus Candida, wherein a plurality of promoting factors (e.g. intestinal candidosis, diabetes mellitus, frequent antibiotic systemic therapies, oral contraceptives, glucocorticoids) in the region of the vulva and the vagina.
PathogenThis section has been translated automatically.
Candida albicans (80-90%)
Candida glabrata (5-10%)
Candida krusei (3-5%)
furthermore C. parapsilosis, C. guilliermondii. and others
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ClassificationThis section has been translated automatically.
- Vesicular or pustular form
- Diffuse eczematous form
- Follicular form.
- vaginal candidiasis:
- Light form (without clear colitis)
- Moderately severe form (signs of inflammation in the sense of colpitis)
- Severe vaginal candidosis (severe colitis).
- Chronic recurrent vulvovaginal candidosis, CRVVC (=/> 4 recurrences within one year)
Occurrence/EpidemiologyThis section has been translated automatically.
75% of women develop vulvovaginal candidiasis at least once in their lives. About 5% of patients suffer from chronic recurrent vulvovaginal candidosis - CRVVC (by definition: at least 4 recurrences per year).
- Vaginal colonization with yeast fungi:
- 10-20% in healthy non-pregnant premenopausal women.
- 20-30% in untreated pregnant women at birth.
- 5-10% in all non-pregnant women.
- > 30% in case of immune deficiency or immunosuppression.
- Predisposing factors: Oral anticontraceptives, pregnancy, diabetes mellitus, immunosuppressive therapy, HIV infection.
- risk groups:
- Younger sexually active women with frequent partner change
- Positive medical history for: pelvic inflammatory disease, extrauterine pregnancy, sterility problems, urethritis, STD.
EtiopathogenesisThis section has been translated automatically.
Vaginal or vulvar colonization with yeast fungi of the genus Candida. Colonisation is usually via the partner's own orointestinal tract or that of the partner, which may also be colonised in semen with the same yeast strain. The vaginal yeast colonization depends on the glucose supply in the vagina.
- C. albicans about 80%.
- C. glabrata 5-10
- C. crusei 1-3
- Rare: C. tropicalis, C. parapsilosis, C. guilliermondii.
Clinical featuresThis section has been translated automatically.
Whitish, partly crumbly fluor vaginalis, oedematous swelling and reddening of the vaginal mucosa with wipeable whitish deposits, pruritus, burning. In severe forms of colpitis up to necrotizing colpitis.
C. albicans infections(80% of the infections) regularly progress with itching and burning as well as with colpitis and/or vulvitis.
C. glabrata infections (about 10% of infections) are asymptomatic; occasional itching and mild burning are reported; vulvitis is very rare.
DiagnosisThis section has been translated automatically.
Clinical inspection of vulva and vagina.
Native preparation from vaginal secretion:
- Vaginal secretion is applied to a slide and mixed with a drop of saline solution. Microscopy at a magnification of 250-400 times. If necessary, phase contrast microscopy (produces more plastic images).
Mycological culture: culture from vaginal secretion. Subcultures on rice agar are required to determine the species of fungus in order to assess the chlamydospore formation of C. albicans. Candida glabrata does not form true mycelia or pseudomycetes.
Differential diagnosisThis section has been translated automatically.
General therapyThis section has been translated automatically.
With a consequent local therapy every vaginal mycosis can be cured.
The high recurrence rate is problematic. In about 10% of women, regular recurrences occur despite sufficient therapy. The co-treatment of the partner is essential, see below. Balanitis candidamycetica.
Cave! Partner may be a carrier even without clinical symptoms.
Possibly treatment of an underlying disease.
Control of the stool flora, exclusion or therapy of intestinal candidosis.
External therapyThis section has been translated automatically.
Antiseptic measures (rinsing or compresses) with octenidine.
The use of vaginal tablets or suppositories is also necessary. Vaginal tablets or ovules are to be inserted deep into the vagina for 1, 3 or 6 consecutive days (depending on the pharmacon).
- Ciclopirox (e.g. inimur myco vaginal suppositories): 1 vaginal suppository must be inserted once a day (in the evening). Alternatively, Batrafen vaginal cream can be applied once a day in the evening for 6 days using a disposable applicator.
- Clotrimazole (e.g. Antifungol Hexal vaginal tablets): 1 time a day, in the evening, 1 vaginal blob for 3 consecutive days.
- Nystatin (e.g. Adiclair vaginal tablets): In the evening, before going to bed, take 1-2 vaginal tablets deep intravaginally. Use for 3 days, 6 days if necessary.
Internal therapyThis section has been translated automatically.
- In recurrent candidosis with C. albicans, a one-day oral therapy with itraconazole preparations(e.g. Siros 2 times/day 200 mg p.o. for 1 day) or fluconazole (e.g. Diflucan®) once 150 mg p.o. can be successful.
- Candida glabrata and Candida krusei are only slightly sensitive to azole antifungals! Therefore, in the case of chronic vaginal complaints caused by C. glabrata, at least 2-3 weeks therapy with fluconazole of at least 750 mg/day is indicated.
- For Candida krusei vaginitis local therapy is usually sufficient.
- In severe cases or if the course of a C. glabrata or C. krusei infection is resistant to therapy, posaconazole can be tried: 400 mg (10 ml) p.o. 2 times/day (daily dose 800 mg) or 4 times/day 200 mg (5 ml) p.o. for 10-14 days.
- In severe cases or if the course of a C. glabrata or C. krusei infection is resistant to therapy, voriconazole can be used alternatively. Adults and children > 12 years. Initially on 1st day of treatment 400 mg p.o. In patients with < 40 kg bw 200 mg p.o. every 12 hours Maintenance dose from 2nd day of treatment: 2 times/day 200 mg p.o. (patient > 40 kg KG) or 2 times/day 100 mg p.o. (Pat. < 40 kg KG). Duration of therapy 3 days.
- If necessary, treatment of an underlying intestinal candidosis, see below Candidosis, enteral.
Notice! In case of excessive colonisation of the intestine (> 104 Kb/g stool) oral treatment with Nystatin.
Progression/forecastThis section has been translated automatically.
ProphylaxisThis section has been translated automatically.
- No washcloths (or disposable washcloths) due to risk of contamination.
- Change underwear and towels every day and cook (for at least 5-10 minutes).
- No tampons (occluding effect!).
- Careful genital cleaning to avoid contamination of the vulva with stool.
- No underwear that is too tight.
- Build up the physiological flora, e.g. with Lactobacillus acidophilus (e.g. Vagiflor).
NaturopathyThis section has been translated automatically.
Diet/life habitsThis section has been translated automatically.
Note(s)This section has been translated automatically.
- Remove material without prior disinfection, in case of discharge by means of an eyelet, but also directly from the speculum on a slide or fungal agar.
- Cover a few drops of specimen material on a microscope slide with a cover glass and, unstained and at medium magnification, examine the specimen for fungal threads and shoot cells.
- For staining, one drop of saturated alcoholic methylene blue solution can be added to the material on the slide. Staining time 30 sec.
- Inoculate fungal agar with plenty of material and incubate at room temperature. Yeasts usually grow after 2-3 days, moulds may take a little longer. Dermatophytes do not cause vaginal mycosis.
- Spread a little of the primary culture on rice extract agar very thin in serpentine or straight lines, cover with cover glass and (very important!) incubate at room temperature for 1-2 days. Do not incubate at 37 °C!
- Candida albicans can be recognized by the typical chlamydospores formed on rice agar. The differentiation of the other yeasts requires physiological examination, e.g. by fermentation of different sugars and organic and inorganic nitrogen.
LiteratureThis section has been translated automatically.
- Duerr A et al (2003) Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity. Obstetric Gynecol 101: 548-556
- Fischer M et al (2000) Vulvodynia. dermatologist 51: 147-151
- Foster DC et al (2002) Vulvar disease. Obstetric Gynecol 100: 145-163
- Marrazzo J (2002) Vulvovaginal candidiasis. BMJ 325: 586
- Mathema B et al (2001) Prevalence of vaginal colonization by drug-resistant Candida species in college-age women with previous exposure to over-the-counter azole antifungals. Clin Infect Dis 33: E23-27
- Merkus J M (1990) Treatment of vaginal candidiasis: orally or vaginally? J Am Acad Dermatol 23: 568-572
- Sobel J D (1990) Individualizing treatment of vaginal candidiasis. J Am Acad Dermatol 23: 572-576
- Sobel J D (1994) Controversial aspects in management of vulvovaginal candidiasis.J Am Acad Dermatol 31: S10-S13
- Stricker T et al (2003) Vulvovaginitis in prepubertal girls. Arch Dis Child 88: 324-326
Incoming links (16)Candidacolpitis; Candidavulvovaginitis; Candidiasis of the vulva; Chronic mucocutaneous candidiasis; Chronic recurrent vulvovaginal candidiasis; Doripenem; Estrogen-progestin combinations; Estrogens; Fenticonazole; Fluconazole; ... Show all
Outgoing links (26)Azole; Bifonazole; Candida albicans; Candida balanitis; Candidosis, enteral; Ciclopirox; Clotrimazole; Fluconazole; Genital herpes; Germ tube test; ... Show all
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