Vaginal candidiasis presents typically with vaginal and vulvar pruritus and burning, which are the cardinal symptoms of the infection. It also presents with white, curdy, and odorless vaginal discharge which often sticks to the vaginal walls [10] [11] [12] [13]. The discharge bears the appearance of cottage cheese. Dyspareunia and dysuria are also common, as are vulvar erythema, swelling, and excoriation. The resulting vaginal sores may spread beyond the vulva to the inguinal and perineal regions. The lesions usually spare the cervix in vulvovaginal candidiasis.

Vaginal candidiasis may present in a cyclic pattern, typically a few days before each menstrual cycle. This is described as cyclic vaginitis.

Typical findings on physical examination include edema and erythema of the vestibule and both labial folds, which are more marked and presenting also with vulvar lichenification in chronic persistent vulvovaginal candidiasis. Chronic vaginal candidiasis occurs, more commonly, in older patients who are also obese and diabetic [14].

Genital candidiasis in men is rare and it usually presents with a pruritic rash on the penis.

A positive history of the predisposing factors of vaginal candidal overgrowth tilts the diagnosis to vaginal candidiasis because the symptoms are often similar to those of other genital infections.

• Candidiasis

  Other Publications That May Help Oral Candidiasis Systemic Candidiasis Preventing Vaginal Candidiasis There are many practical ways to try to prevent vaginal candidiasis. [thebody.com]

  Introduction Vulvovaginal candidiasis (VVC) is a fungal or yeast infection of the female lower genital tract, the vulva, and the vagina caused by Candida spp. 1 – 3 It can be referred to as candidiasis or moniliasis. [dovepress.com]

  Diabetes Mellitus Vulvovaginal Candidiasis Drug: Boric Drug: Fluconazole Phase 3 Detailed Description: A high proportion of vulvovaginal candidiasis is due to C.glabrata that responds poorly to fluconazole therapy. [clinicaltrials.gov]

  Most cases of vaginal candidiasis are seen in women of reproductive age, especially pregnant women. Recurrent vaginal candidiasis is defined as at least 4 confirmed episodes of vaginal candidiasis within a 12-month period. [symptoma.com]

  Women living with HIV are more likely to experience recurrent vaginal candidiasis than women who are HIV negative. Esophageal candidiasis : This type of candidiasis occurs deep down in the throat and can’t always be seen by looking into the mouth. [poz.com]

• Recurrent Infection

  They also show that C. albicans strains that cause recurrent infections are less similar to each other than strains that cause one-off infections, suggesting that the former may represent more virulent subtypes. [ncbi.nlm.nih.gov]

  Other considerations in recurrent infection Give general advice as with non-recurrent infection. [patient.info]

  Other factors that may predispose to recurrent infection include abnormalities in local vaginal mucosal immunity and genetic susceptibility. [emedicine.medscape.com]

  J Infect Dis 2002, In press. Google Scholar 7. Vazquez JA, Sobel JD, Demitriou R, et al. : Karotyping of C. albicans obtained longitudinally in women with recurrent vulvovaginal candidiasis. J Infect Dis 1994, 170 :1566–1569. [link.springer.com]

• Chronic Infection

  The results obtained in the Maria Hospital, Tilburg, The Netherlands, and a review of foreign data suggest the following: (1) For acute infection oral and topical agents produce equivalent results. (2) For chronic infections oral medication is preferred [jaad.org]

  A culture test will help determine if a Candida species other than C. albicans is causing your chronic infection (such as C. glabrata or C. krusei) — some yeast species are resistant to the drugs used to treat a C. albicans infection. (7) Symptoms of [everydayhealth.com]

  For milder infections, your doctor may recommend one 150-milligram dose, but “for severe or chronic infections, treatment regimens using fluconazole can be taken daily or weekly for six months,” she says. [prevention.com]

  The most common infection sites are on the skin or mucous membranes, specifically the mouth and vagina, known as mucocutaneous infections. [6] Mucocutaneous infection sites are chronic infections of the hair, skin, nails and regions with a mucus membrane [austincc.edu]

• Fatigue

  SYMPTOMS: Recurring yeast infections, UTI’s or vaginal bacterial infections Tiredness, fatigue, Brain-fog Sinus infections – recurring and long-term Digestive issues Skin & Nail problems (i.e. acne, nail fungus) Suppressed immune system Diabetes Anxiety [yoninutritionist.com]

  Its basic cause can be a weak immune system and symptoms can be fatigue, abdominal pain, and canker sore. Herbs to Cure Candidiasis  Herbs that can help you fight Candidiasis are Clove essential oil, Grapefruit, Sage and many more. [slideshare.net]

  A high sugar diet or too much sugar in the bloodstream, as associated with diabetes, or excessive alcohol provides ample nourishment for Candida growth. [6] Other risk factors include fatigue, hormonal fluctuations (especially for women during the menstrual [austincc.edu]

  Low energy, fatigue. Poor memory, focus issues, brain fog. Behavior changes and mood swings. Headaches, migraines. Sinus infection. Weight gain, difficulty to lose weight, eating disorders. Muscles or joints pain. Hormonal imbalance. Low sex drive. [candidaspecialists.com]

  Case#2: 37 yo woman with allergic rhinoconjunctivitis, recurrent sinus infections, asthma, chronic fatigue syndrome and recurrent oral ulcers, vaginal yeast infections and a fairly persistent skin rash (underarms and sometimes under breasts). [aaaai.org]

• Weight Gain

  The Diet Cure: The 8-Step program to Rebalance your Body Chemistry and End Food Cravings, Weight Gain and Mood Swings Naturally. Penguin: New York. [holistickenko.com]

  Weight gain, difficulty to lose weight, eating disorders. Muscles or joints pain. Hormonal imbalance. Low sex drive. Allergies. [candidaspecialists.com]

• Cough

  Therefore, health-care providers should be alert for symptoms or signs that suggest advanced HIV infection (e.g., fever, weight loss, diarrhea, cough, shortness of breath, and oral candidiasis). [cdc.gov]

• Vomiting

  HIV-AIDS), have multiple sexual partners or change partners often You are under 12 years old You have fever, chills, nausea, or vomiting You have a smelly or unusual discharge You feel abdominal pain You have heart disease You have previously had an allergic [canesten.ca]

  […] than 2 months There is no improvement in your symptoms within three days, or if they’ve not disappeared within seven days You are pregnant or breastfeeding You have multiple sexual partners You are under 12 years old You have fever, chills, nausea, or vomiting [canesten.co.uk]

  Occasionally they cause side-effects such as nausea and vomiting, diarrhoea or constipation and bloating. [netdoctor.co.uk]

  […] symptoms of thrush you have had more than three thrush infections in the past year, or an infection within the last two months your symptoms have not gone away, despite treatment you are pregnant or breastfeeding you also have lower abdominal pain, fever, vomiting [mydr.com.au]

• Dysphagia

  Although patients are frequently asymptomatic, when symptoms do occur, they can include the following: Sore and painful mouth Burning mouth or tongue Dysphagia Thick, whitish patches on the oral mucosa Physical examination reveals a diffuse erythema and [emedicine.medscape.com]

• Ulcer

  RESULTS: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritus, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. [ncbi.nlm.nih.gov]

  Oral ulcers are often non-infectious (has anything ever been isolated?) and I'd be reluctant to treat her oral ulcers with fluconazole without microbiological proof. [aaaai.org]

  The bark of leaves of this group is used as astringent, haemostatic, anti-inflammatory, anti-septic and is prescribed in diarrhoea, dysentery and in the treatment of skin disease, ulcers, vaginal disorders, leucorrhoea, menorrhagia, deficient lactation [imbuenatural.com]

  COMPLICATIONS: ADD/ADHD Skin Conditions – Eczema, Psoriasis, Hives, Rash Hashimoto’s Thyroiditis Rheumatoid Arthritis Bowel problems – Ulcerative Colitis, Crohn’s Disease, IBS Lupus Multiple Sclerosis Fibromyalgia Chronic Fatigue Syndrome Depression/Anxiety [yoninutritionist.com]

  In patients with vulvar or vaginal ulcerations, herpes cultures are indicated. [aafp.org]

• Sweating

  Abstract A secretor is an individual who secretes blood group antigens into body fluids such as saliva, sweat, tears, semen and serum. [ncbi.nlm.nih.gov]

  These may cause irritation and sweating. Wear cotton underwear or cotton-crotch pantyhose. Avoid underwear made of silk or nylon. These can increase sweating in the genital area, which leads to growth of more yeast. [nlm.nih.gov]

• Flushing

  Be careful to hold the bag below the pelvis and to exert only slight pressure on the bag as you want to flush out the vaginal canal only and not push the solution up through the cervix into the uterus. [nationalcandidacenter.com]

  An apple cider vinegar bath is not the same as douching, which aims to flush out all bacteria (good and bad) from your vagina. Doing so leaves you more prone to a reoccurrence of the yeast infection. Do not douche with apple cider vinegar. [healthline.com]

• Eczema

  Particular attention needs to be paid to alternative diagnoses, most commonly vulval eczema/dermatitis. [sti.bmj.com]

  COMPLICATIONS: ADD/ADHD Skin Conditions – Eczema, Psoriasis, Hives, Rash Hashimoto’s Thyroiditis Rheumatoid Arthritis Bowel problems – Ulcerative Colitis, Crohn’s Disease, IBS Lupus Multiple Sclerosis Fibromyalgia Chronic Fatigue Syndrome Depression/Anxiety [yoninutritionist.com]

  Eczema. Psoriasis. Mechanical irritation - eg, long-distance cyclists, sexual abuse in girls. Rectovesical fistula. Urinary tract infection. Investigations Routine vaginal swabs are not required. [patient.info]

  […] course of antibiotics or steroids have diabetes and your blood sugar is not under control use a type of hormonal birth control that has higher doses of oestrogen have a weakened immune system, such as from chemotherapy have a skin condition such as eczema [healthnavigator.org.nz]

• Urticaria

  Of the adult U.S. population, 3%--10% have experienced an immunoglobulin E (IgE) mediated allergic response to penicillin such as urticaria, angioedema, or anaphylaxis (i.e., upper airway obstruction, bronchospasm, or hypotension). [cdc.gov]

• Vaginal Discharge

  The diagnosis can be made clinically on the basis of the description and appearance of the vulva, vaginal discharge or glans penis in men. The diagnosis of vaginal candidiasis can be confirmed on high vaginal swab. [hse.ie]

  RESULTS: The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. [ncbi.nlm.nih.gov]

  Exclusion Criteria: Patients with vaginal discharge in whom Candida growth was not detected on fungal culture were excluded. [clinicaltrials.gov]

  Other names used for vulvovaginal candidiasis are 'vaginal thrush’, ‘monilia’, and ' vulvovaginal candidosis'. What causes vaginal discharge ? Vaginal discharge is a normal process which keeps the mucosal lining of the vagina moist. [dermnetnz.org]

• Pruritus Vulvae

  Presentation [ 1 ] Symptoms Pruritus vulvae. Vulval soreness. White, 'cheesy' discharge. The discharge is non-offensive. Foul-smelling or purulent discharge suggests bacterial infection. Dyspareunia (superficial). Dysuria (external). [patient.info]

  vulvae; 15 therefore, to have a definitive diagnosis of VVC, cultural isolation and identification of Candida spp. are crucial. [dovepress.com]

• Vulvar Burning

  Dr Martin assured women that the symptoms of a yeast infection — vaginal or vulvar burning or itching, white thick cottage cheese appearing discharge and swelling of the vulva — are quite common and easily remedied by a doctor. [jamaicaobserver.com]

  Patients with VVC may also complain of irritation, soreness, vulvar burning, or dyspareunia. Occasionally, VVC can cause external dysuria by the burning that occurs when urine hits the inflamed vulvar tissues ( Eckert 1998 ). [dx.doi.org]

  Women with VVC may also complain of irritation, soreness, vulvar burning or dyspareunia. [doi.org]

• Cheesy Vaginal Discharge

  Minority of women have vaginitis symptoms such as increase yellowish or cheesy vaginal discharge with vulva itchiness, vaginal soreness, or discomfort during sexual intercourse. [fhs.gov.hk]

In vaginal candidiasis, vaginal PH remains normally at less than 4.5 [15] [16]. A diagnosis of vaginal candidiasis is made by the detection of candidal species on wet mount or KOH preparation of candidal smear on a microscopic analysis. Vaginal smears for microscopic analysis should be ordered to confirm suspected cases of vaginal candidiasis.

The wet mount involves microscopic examination of vaginal scrapings from the vulvar lesions or drops of the vaginal discharge after being mixed with a few drops of physiologic saline. Microscopic examination is done at low and high power magnifications and reveals pseudohyphae, budding yeast, or mycelia. In up to 50% of symptomatic patients with vaginal candidiasis, the pseudohyphae and yeast spores are detected on microscopy [17] [12].

In the absence of positive findings on microscopy, with symptoms suggestive of vaginal candidiasis, a fungal culture is done. Smears of the vaginal and vulvar are cultured. A fungal culture is also indicated in recurrent vaginal candidiasis to confirm the diagnosis and exclude Candidiasis caused by species other than Candida Albicans.

Treatment of vaginal candidiasis consists typically of antifungal medications of the imidazole group. Topical or oral forms are effective. Topical clotrimazole, miconazole, tioconazole and butoconazole can be found over-the-counter, however, hypersensitivity to these topical agents is suggested with an exarcebation or persistence of symptoms. Furthermore, topical medications containing vegetable oil or mineral oil tend to weaken latex condoms. All the drugs are equally effective.

The azole component in these imidazole antifungal drugs inhibits the synthesis of ergosterol, which is the main component of candidal cell wall formation. Therefore, these antifungal agents have a cure rate of over 80%. The US Food and Drug Administration (FDA) currently approves only of fluconazole as the oral treatment of choice for vulvovaginal candidiasis. A single-dosage regimen of 150mg fluconazole proffers better treatment compliance. Single-dose itraconazole is an effective alternative. Therapeutic levels are attained after 72 hours of the single dosage of fluconazole [18]. Fluconazole is, however, contraindicated in pregnancy and before considering its use, pregnancy should be ruled out. Anti-pruritic medications may provide relief of the itch.

Recurrent cases of vaginal candidiasis are treated with a longer course of treatment and need to be investigated for non-Albicans vaginal candidiasis which is treated with boric acid. There is no recommendation for routine treatment of sexual partners. Screening for immunosuppressive diseases such as HIV is necessary in recurrent cases of vulvovaginal candidiasis.

Home remedies for vaginal candidiasis involve keeping the vulva clean and dry. Vulvar and vaginal moisture can be eliminated by wearing absorbent and loose clothing. Reducing genital moisture inhibits fungal growth.

Vaginal candidiasis responds well to treatment, however recurrences are frequent in more than half of the cases.

Most cases of fungal vaginitis are caused by Candida Albicans. Candida species including C. albicans, C. tropicalis and C. glabrata are airborne microbes, which are part of the normal vaginal flora in up to 20% of non-pregnant women of reproductive age and 40% of pregnant women. Vaginal candidiasis is the most common cause of vaginitis.

Candidal vaginitis is a result of candidal overgrowth in the vagina. Conditions which, therefore, cause candidal vaginitis by causing candidal overgrowth include pregnancy, diabetes mellitus, prolonged use of broad-spectrum antibiotics, use of steroids, oral contraceptives, IUD, wearing tight-fitting undergarments, iron deficiency anemia, frequent sexual intercourse, and immunosuppressive diseases such as HIV. The infection, however, is not contracted via sexual intercourse. The infection is most frequently seen and more severe in immunosuppressed patients.

Estrogen causes proliferation of the endometrium and increased production of glycogen in the vagina. Glycogen, in turn, is a source of nutrition and growth for candida albicans. Therefore, women with low estrogen levels,such as prepubertal and postmenopausal women have a very low risk of developing vaginal candidiasis. However, cases are frequent in postmenopausal women on hormone replacement therapy.

Vaginal candidiasis may also cause superimposed infection on preexisting skin diseases including psoriasis and lichen planus.

In the United States, approximately 10-50% of women in their reproductive age are asymptomatic carriers of vaginal candidiasis. Up to 75% of all women have had vaginal candidiasis at least once in their lifetime, a few of whom have recurrent episodes of the infection [3] [4] [5] [6] [7].

Recurrence of vaginal candidiasis occurs commonly in chronic immunosuppressive diseases such as diabetes, therefore, necessitating screening for diabetes mellitus. Most cases of vaginal candidiasis are seen in women of reproductive age, especially pregnant women [8]. Recurrent vaginal candidiasis is defined as at least 4 confirmed episodes of vaginal candidiasis within a 12-month period [9].

Factors which alter the normal vaginal state or secretions predispose to candidal proliferation and development of vaginal candidiasis. The infection is not sexually transmitted.

Pregnancy is one of the commonest risk factors for vulvovaginal candidiasis. Pregnancy is characterized by increased levels of reproductive hormones and vaginal glycogen level, both of which promote growth, proliferation, and adherence of the Candida species. Additionally, the vaginal environment becomes acidic in pregnancy, suppressing other microbes found in the vagina, some of which serve to inhibit the growth of Candida, contributing to the susceptibility of pregnant women to vaginal candidiasis.

Antibiotics reduce the amount of healthy and protective resident bacteria in the vagina, therefore predisposing to the growth of Candida. Antibiotics commonly implicated include cephalosporins, penicillins, tetracycline, and other broad-spectrum antibiotics.

Wearing tight-fitting undergarments also plays a role in the pathogenesis of vaginal candidiasis. These promote heat and moisture which encourage candidal growth.

Preventive measures include reduction of dietary sugar intake, as it has been shown that dietary sucrose and lactose promote fungal growth. Wearing nonocclusive, loose, and absorbent clothing prevents moisture and heat around the genitals, thereby preventing overgrowth of candidal species. Cotton undergarments also serve to reduce the moisture and heat in the genital area. Women with recurrent vaginal candidiasis may require prophylactic oral or intravaginal probiotics.

Vaginal candidiasis is also known as vaginal thrush, candidal vaginitis, vaginal candidosis and monilia. It is the commonest cause of vaginitis and as many as three out of every four women have been affected by it at some point in their life [1].

Vaginal candidiasis is caused by the overgrowth and predominance of candidal species, particularly Candida Albicans, due to certain predisposing conditions, including diabetes, prolonged antibiotic treatment, frequent sexual intercourse, steroid use, pregnancy, use of oral contraceptives and an immunodeficient state. However, it is not contracted via sexual intercourse.

It is also frequently seen in women of reproductive age, being very rare in children and postmenopausal women. Recurrence occurs in up to 10% of women [2].

Typical features of candidal vaginitis include vaginal pruritus, burning, and a thick, cottage-cheese-like vaginal discharge which is often odorless. It is very responsive to treatment with oral or topical antifungal agents, although resistant infection may be seen in some women.

Diagnosis is made by microscopic examination of vaginal smears which characteristically reveals candidal spores and pseudohyphae. However, cultures of vaginal lesions or the vaginal discharge, as well as screening for diabetes and immunosuppressive diseases, may be necessary in chronic and recurrent cases.

Vaginal candidiasis, also called vaginal thrush, is an infection of the vulva and vagina which is caused by a yeast called Candida, most commonly by a species called Candida Albicans. Yeast is found normally in the vagina along with other healthy microorganisms and the infection results from an overgrowth of yeast due to certain predisposing factors. This condition is the most common cause of inflammation of the vagina.

Factors which reduce the amount of healthy microorganisms in the vagina cause growth, development, and attachment of the yeast to the vaginal walls, leading to a yeast infection. These factors include diabetes, use of antibiotics, use of steroids, intrauterine contraceptive devices, oral contraceptives and factors which weaken the immune system, including immune diseases such as HIV. Yeast infections are very common in women of reproductive age and are particularly common in pregnant women. It is rare in children and women who are past the age of menopause. This is due to the fact that the female hormone, estrogen, which promotes the overgrowth of Candida, is low in these age groups.

Yeast infection commonly occurs within the days before the menstrual flow and is often worsened by sexual intercourse. The infection presents as vaginal and vulvar itching and burning with white, thick, and odorless vaginal discharge which resembles cottage cheese. In addition, the vulva may appear red and swollen. The symptoms are severer in patients with diseases which weaken the immune system. Occasionally, there may be pain during sexual intercourse and urination.

Yeast infection has affected 3 out of every 4 women at a point in their lifetime. More than 50% of all women who have had the infection have recurrent or persistent infection. A few of the women affected may go on to have more than 4 cases within a year.

Doctors reach the diagnosis of yeast infection by taking swabs of the vaginal discharge or scrapings of the vaginal sores to examine for yeast under a microscope. Findings of the yeast reproductive forms under the microscope confirms the diagnosis. In some women with prolonged cases, the microscopic examination may be negative, necessitating a culture of the vaginal sores or discharge.

Treatment of yeast infection is with antifungal drugs. These drugs could come in forms of tablets, creams, ointments or suppositories inserted into the vagina. Some forms such as clotrimazole, miconazole, tioconazole and butoconazole creams are available over the counter. Of note is that some of these creams may contain mineral oil, which weakens latex condoms, therefore, making it an unreliable form of contraception during the period of treatment.

Fluconazole is a common oral form of treatment and is often taken as a single dose. Itraconazole is an effective alternative which could also be taken as a single dose. Although, these drugs are available without a doctor's prescription, a pregnant woman with vaginal candidiasis should not use fluconazole as this drug could affect the baby. If one must use this drug, the patient must test negative for pregnancy.

Higher doses of these oral drugs would be required in patients with persistent infection. Treatment of patients' sexual partners is often not necessary. Over-the-counter anti-itch medication may be taken to relieve the itch.

Yeast infection can be prevented by keeping the vaginal area dry. This can be achieved by wearing loose, absorbent and 100% cotton undergarments. Reducing the intake of sugar also reduces the risk of getting the infection, because sugar has been shown to foster overgrowth of yeast in the vagina.

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