Vaginal candidiasis (vaginal yeast infection) – mycosis of the mucous membrane of the vagina, which occurs when it is colonized by strains of yeast-like Candida fungi.
In the acute stage, there is redness, swelling and itching of the vulva; soreness, burning and itching in the vagina; copious, cheesy type of discharge from the genital tract; in chronic – dryness and atrophy of the mucous membrane, excoriation, severe lichenisation.
The diagnosis of vaginal candidiasis is established according to the clinical picture, microscopic and cultural studies. In case of vaginal candidiasis, systemic and local antimycotic drugs, multivitamins, and immunostimulants are prescribed.
Vaginal candidiasis: what is Vaginal yeast infection?
Vaginal candidiasis, or thrush – a type of vaginal fungal infection, the causative agent of which are microscopic yeast-like fungi of the genus Candida albicans (Candida albicans). Candida infection is of great importance in obstetrics and gynecology due to the widespread and increasing incidence in recent years. Among vaginal infections, candidiasis ranks second after bacterial vaginosis.
Vaginal candidiasis usually affects women of childbearing age (pregnant women — 2-3 times more often), before the onset of menarche and in postmenopausal women is rare. Yeast infection of the vagina can exist in the form of asymptomatic candidiasis and true vaginal candidiasis – acute (up to 2 months) and chronic recurrent (lasting more than 2 months).
Causes of Vaginal Candida
Vaginal candidiasis is caused by conditionally pathogenic yeast-like fungi of the genus Candida that inhabit the skin and mucous membranes of the oral cavity, gastrointestinal tract, vulva and vagina of healthy women. The change of growth phases (pseudo-micelles and blastospores) allows fungi to survive in a wide temperature and acid range.
The death of Candida causes boiling for 10-30 minutes, treatment with formalin, blue vitriol, carbolic acid and boric acid. The presence of mannoprotein membranes and enzymes (proteases and catalases) in fungi makes it easier to resist the immune system of the microorganism.
The dominant pathogens of vaginal candidiasis (in 75-80% of cases) are the strains of C. albicans, which have a large pathogenic potential. Vaginal candidiasis caused by other species (C.glabrata, C. tropicalis, C. krusei, C.parapsilosis) is more typical for certain ethnic groups (representatives of the African race) and geographical areas (the coast of the Mediterranean, the Middle East), which is associated with microbiocenosis of mucous membranes and skin, nutrition and living conditions.
As a rule, vaginal candidiasis is an endogenous infection that develops in conditions of asymptomatic candidates, usually vaginal, less often on the mucous membrane of the mouth, intestines and skin. For example, the recurrent form of vaginal candidiasis is due to the persistence of candidates in the intestines and the periodic entry of the pathogen into the vagina and its colonization.
In vaginal candidiasis, pseudo-mycelium candida usually penetrates only into the superficial layers of the vaginal epithelium, less often affects deeper tissues, followed by hematogenous spread and damage to various organs.
The emergence of vaginal candidiasis contributes to the failure of the protective system of the host body, manifested by a decrease in local immunity of the vagina.
Local immunodeficiency against Candide antigens (decreased activity of macrophages and lymphocytes) does not allow blocking fungal receptors and enzymes.
Vaginal candidiasis is usually not accompanied by a marked decrease in the level of lactobacilli and a change in the normal microflora of the vagina; but in the formation of polymicrobial associations can be combined with bacterial vaginosis.
The development of vaginal candidiasis has an imbalance of sex hormones during pregnancy, hormonal contraceptives, endocrine pathology. The effect of fluctuations in estrogen and progesterone on the vaginal mucosa is manifested by an increase in the concentration of glycogen in epithelial cells, stimulation of their sensitivity to candida, and more effective adhesion of fungi.
Vaginal candidiasis is more often accompanied by various conditions associated with immunosuppression (HIV infection, diabetes, tuberculosis, hypovitaminosis, excessive use of antibiotics, corticosteroids, cytotoxic drugs, radiation therapy, etc.). Vaginal candidiasis may be associated with atopic manifestations (allergic rhinitis, food allergies).
Nutritional errors, the use of hygiene products (pads, tampons), wearing tight clothes are not considered to be significant factors in the development of vaginal candidiasis.
There is a possibility of transmission of candida infection to the newborn when passing through the birth canal to the sick mother; possible sexual route of infection; the risk of infection is higher with frequent oral-genital contacts.
Symptoms of vaginal candidiasis
There are no clinical manifestations in candidature; patients, as a rule, do not make any complaints. In acute vaginal candidiasis, there are abundant thick white-gray discharge from the vagina, a cheesy look with a sour odor.
The mucous membrane affected by vaginal candidiasis is edematous, hyperemic and prone to bleeding. It is marked by sharply delimited or merging with each other rounded and oval pockets of cheesy plaque and films, ranging in size from pinpoint to 5-7 mm in diameter.
In the acute phase, the raids are tightly attached to the mucous membrane and are barely peeled off with a shiny eroded surface exposed with a scalloped edge; later easily removed, standing out from the genital tract. Typical for vaginal candidiasis is itching and burning in the vulva, aggravated during menstruation, after physical activity, water procedures. Patients are also concerned about the sharp painful feelings during intercourse.
In chronic vaginal candidiasis, the absence of characteristic secretions is possible, there is a slight hyperemia of the mucous membrane, scanty films and dry erosion, severe excoriation. The mucous membrane becomes flabby, atrophic, the entrance to the vagina is narrowed, hemorrhagic rashes may appear. The chronic form has a long perennial course.
Vaginal candidiasis usually spreads to the external and internal genital organs, the urethra with the development of vulvovaginal candidiasis, cervicitis and urethritis. Vaginal candidiasis can be the cause of termination of pregnancy (miscarriage, premature birth), the development of endometritis in the postpartum period, infertility.
Diagnosis of vaginal candidiasis
The diagnosis of vaginal candidiasis is confirmed by the presence of clinical signs of infection and the isolation of a culture of fungi from the vaginal mucosa during a microbiological study. Examination of the cervix and vagina with the help of mirrors reveals hyperemia, puffiness of the mucous membrane, gray-white cheesy raids in its folds.
When staining with Lugol’s solution, small-dotted blotches and pronounced vascular pattern appear. Discharge in vaginal candidiasis is found in about 76% of cases, itching – in 32%.
Microscopic examination of the smear determines the round-oval, sometimes budding cells.
Species identification of fungi and determination of their sensitivity to drugs, complex PCR diagnostics and ELISA for STI pathogens are carried out. If necessary, the examination is supplemented with bacteriological examination of urine and urethral smear on the microflora, stool analysis for dysbacteriosis, blood sugar, pelvic ultrasound, abdominal cavity and bladder ultrasound.
Treatment and prevention of vaginal candidiasis
Comprehensive treatment of vaginal candidiasis includes the effect on the pathogen – Candida fungi, the elimination of provoking factors, therapy for comorbidities.
In case of vaginal candidiasis, various groups of antifungal agents are applied systemically and locally:
- polyene antibiotics,
- antimycotics of the imidazole and triazole series.
Good results in the treatment of vaginal candidiasis are shown by fluconazole, which has a broad spectrum of fungistatic action and does not give a side effect on steroid synthesis and metabolism. The effectiveness of a single high dose oral administration gives an advantage over other antimycotics.
In case of a mild course, local preparations are shown in the form of a cream, vaginal suppositories and tablets. In chronic infections, taking systemic antifungal drugs is repeated in certain courses. It is preferable to prescribe low-toxic forms of antimycotics to pregnant women and in children.
Therapy for vaginal candidiasis can be supplemented by topical application of disinfectants and anti-inflammatory drugs – borax solutions in glycerol, potassium permanganate and silver nitrate in the form of baths and douches. In vaginal candidiasis of polymicrobial genesis, combinations of antimycotics with metronidazole are prescribed. Immunostimulatory correction is carried out by immunostimulating agents, multivitamins are indicated. The cure rate for vaginal candidiasis is determined by the disappearance of clinical signs and the negative result of a microbiological study.
Prevention of vaginal candidiasis is to eliminate the conditions for its development:
- limiting the reception of COCs, antibiotics, cytostatics;
- drug correction of immunodeficiency, endocrinopathy and other concomitant diseases, preventive examination of women by a gynecologist.