(See also Overview of Vaginitis Overview of Vaginitis Vaginitis is infectious or noninfectious inflammation of the vaginal mucosa, sometimes with inflammation of the vulva. Symptoms include vaginal discharge, irritation, pruritus, and erythema... read more .)
Most fungal vaginitis is caused by C. albicans (candidiasis Candidiasis (Mucocutaneous) Candidiasis is skin and mucous membrane infection with Candida species, most commonly Candida albicans. Infections can occur anywhere and are most common in skinfolds, digital... read more ), which colonizes 15 to 20% of nonpregnant and 20 to 40% of pregnant women.
Risk factors for candidal vaginitis include the following:
Use of a broad-spectrum antibiotic or corticosteroids
Constrictive nonporous undergarments
Candidal vaginitis is uncommon among women who are postmenopausal, except among those taking systemic menopausal hormone therapy Menopausal Hormone Therapy Menopause is the permanent cessation of menses (amenorrhea) due to loss of ovarian follicular function. Clinical manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary... read more .
Symptoms and Signs of Candidal Vaginitis
Vulvovaginal pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common, as is a thick, white, curd–like vaginal discharge that adheres to the vaginal walls. Symptoms and signs increase the week before menses. Erythema, edema, and excoriation are common.
Women with vulvovaginal candidiasis may have no discharge, a scanty white discharge, or the typical curd-like discharge.
Infection in sex partners is rare.
Recurrences after treatment may occur if there is resistance to antifungals or if a patient has non- Candida albicans species like Candida glabrata.
Diagnosis of Candidal Vaginitis
Vaginal pH and microscopy
Culture, if vaginitis is persistent or recurrent
Criteria for diagnosing candidal vaginitis include
Typical discharge (a thick, white, curd-like vaginal discharge)
Vaginal pH is < 4.5
Budding yeast, pseudohyphae, or mycelia visible on a wet mount, especially with potassium hydroxide (KOH)
If symptoms suggest candidal vaginitis but signs (including vulvar irritation) are absent and microscopy does not detect fungal elements, fungal culture is done. Women with frequent recurrences require culture to confirm the diagnosis and to rule out non-albicans Candida.
Also, some diagnostic tests are commercially available for clinical use (1 Diagnosis reference Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. Symptoms are usually a thick, white vaginal discharge and vulvovaginal pruritus that is often... read more ).
Treatment of Candidal Vaginitis
Antifungal medications (fluconazole in a single oral dose preferred)
Avoidance of excess moisture accumulation
Keeping the vulva dry and wearing loose, absorbent cotton clothing that allows air to circulate can reduce vulvar moisture and fungal growth.
Topical or oral medications are highly effective for candidal vaginitis (see table ). Adherence to treatment is better when a one-dose oral regimen of fluconazole 150 mg is used.
New oral antifungal medications to treat candidal vaginitis include ibrexafungerp and oteseconazole. Clinical use of these varies. Some experts advise treatment with these antifungals in symptomatic patients who fail topical azoles and/or oral fluconazole as documented by saline microscopy or fungal culture.
Topical butoconazole, clotrimazole, miconazole, and tioconazole are available over the counter. However, patients should be warned that topical creams and ointments containing mineral oil or vegetable oil weaken latex-based condoms and diaphragms.
If symptoms persist or worsen during topical therapy, hypersensitivity to topical antifungals should be considered.
Patients who have frequent recurrences (at least 4 documented episodes of candida vaginitis in the previous 12 months) require long-term suppression with oral medications (fluconazole 150 mg weekly to monthly or ketoconazole 100 mg once a day for 6 months) (1 Treatment reference Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. Symptoms are usually a thick, white vaginal discharge and vulvovaginal pruritus that is often... read more ). Suppression is effective only while the medications are being taken. These medications may be contraindicated in patients with liver disorders. Patients taking ketoconazole should be monitored periodically with liver tests.
Drugs Mentioned In This Article
|Drug Name||Select Trade|
|Alevazol , Antifungal, Anti-Fungal, Cruex, Desenex, Fungoid, Gyne-Lotrimin, Lotrimin, Lotrimin AF, Lotrimin AF Ringworm, Micotrin AC, Mycelex, Mycelex Troche, Mycozyl AC|
|Aloe Vesta, Antifungal, AZOLEN TINCTURE, Baza, Cruex, Desenex, Desenex Jock Itch, Fungoid, Lotrimin AF, Lotrimin AF Antifungal Liquid, Lotrimin AF Deodorant, Lotrimin AF Powder, Lotrimin AF Spray, Micaderm , Micatin, Miconazole 7, Micotrin AP, Micro-Guard , Mitrazol, Monistat 1 Day or Night Combination Pack, Monistat 1 Vaginal Ovule Combination Pack, Monistat 1 Vaginal Ovule Combination Pack (Prefilled), Monistat 3, Monistat 3 Vaginal Cream (Prefilled), Monistat 3 Vaginal Cream Combination Pack, Monistat 3 Vaginal Cream Combination Pack (Prefilled), Monistat 3 Vaginal Ovule Combination Pack, Monistat 3 Vaginal Suppositories Combination Pack, Monistat 7, Monistat 7 Vaginal Cream Combination Pack, Monistat-Derm, Mycozyl AP, Neosporin AF, Novana Anti-Fungal, Oravig, Remedy, Soothe & Cool INZO, Ting Antifungal, Triple Paste AF , Vagistat-3, Zeasorb Athlete's Foot, Zeasorb Jock Itch|
|1-Day, Monistat 1 Simple Therapy, Vagistat-1|
|Fleet, Kondremul, Liqui-Doss, Muri-Lube|
|Extina, Ketodan, Kuric, Nizoral, Nizoral A-D, Xolegel|