What Is Vaginal Candidiasis?

Simple vulvovaginal candidiasis refers to vulvovaginitis caused by women's infection with Candida albicans (Candida albicans), which mainly manifests itching and burning of the vulva, restlessness, urgency and frequent urination in severe cases The general symptoms are mild or moderate, more common in women, and children can also be affected. It is a common inflammatory disease of female reproductive tract infections. It is a type of vulvovaginal candidiasis. Compared with complex vulvovaginal candidiasis, it is The most common vulvovaginal infection, second only to bacterial vaginosis, is about 70% of women infected at least once in their lifetime.

Basic Information

English name

simple vulvovaginal candidiasis

Visiting department

Gynecology

Multiple groups

Women

Common causes

Decreased local and vaginal local immunity, especially local cellular immunity

Common symptoms

Itching, increased vaginal discharge, irritation and pain during intercourse

Contagious

no

Causes of simple vulvovaginal candidiasis

85% to 90% are caused by Candida albicans, and other Candida and Pseudococcus infections are rare. Candida albicans is a conditional pathogen. In asymptomatic healthy reproductive-age women, the detection rate of candida is about 20%, but the amount of bacteria is very small, showing a yeast phase, and does not cause symptoms. Symptoms of vaginal inflammation can only occur when the local immunity of the whole body and vagina is reduced, especially the local cellular immunity is reduced, Candida multiplies, and transforms into a hyphae phase.

Generally, when vaginal glycogen increases and acidity increases, it is most suitable for Candida reproduction. Therefore, in the case of pregnancy, diabetes, obesity, thyroid and adrenal insufficiency, it is more likely to suffer from vulvovaginal candidiasis. Oral contraceptives, the use of corticosteroids, immunosuppressants, antibiotics, preference for sweets, and wearing tight chemical fiber underwear can affect the reproduction and growth of Candida and cause disease. In addition, when there are pathological changes in the vagina and cervix, the incidence of Candida is also increased.

Clinical manifestations of simple vulvovaginal candidiasis

The severity of symptoms depends on the infection bacterium and strain and the susceptibility of the patient. Those with mild symptoms can only have mild itching without other clinical symptoms. Aggravated one week before menstruation and some relief after menstruation.

Itching

The skin is flushed and swollen, and it is consciously and severely itchy, which may be accompanied by burning sensation in the vulva and vagina. Symptoms may worsen when the environment is warm or when wearing bodysuits or synthetic fabrics.

2. Increased leucorrhea

The inside of the labia minora and the surface of the vaginal mucosa are covered with white flakes or curds. Typical is a large number of white thick curd-like or tofu-like leucorrhea.

3. Other

May have vaginal pain, irritation, frequent urination and difficulty in intercourse.

Simple vulvovaginal candidiasis test

Gynecological examination

Vulvar flushing, edema, clusters of small papules, blisters, or eczema-like erosions, erythema on maps, and scratches or cracks can be seen on the inside of the labia; the inside of the labia minora and the vaginal mucosa are covered with white membranous scum-like secretions. The mucosa is highly congested, red and swollen, and individual patients have ulcers.

2. Auxiliary inspection

(1) Direct test is the most commonly used test in clinical practice, with a positive detection rate of 60%. Its advantages are simple and fast. Use a long sterile cotton swab to take the vaginal, cervical secretions, or the milky white film on the vaginal wall as the specimen to be tested. Microscopic examination reveals spores and fungal hyphae.

(2) Gram staining The positive detection rate of this method is 80%. Secretion smears were taken and fixed, and then Gram stained and observed under a microscope. Groups of Gram-positive oval spores and pseudohyphae were seen. After Congo red staining or PAS staining, the positive rate was higher than that of direct microscopy. Gram stain, spores and pseudohyphae stained blue: Congo red and PAS stain, spores and pseudohyphae stained red.

(3) Cultivation method If suspected to be Candida vaginitis, multiple tests are negative, which can be used for fungal culture. Usually, if the patient has typical clinical manifestations and sees spores and pseudohyphae under the microscope, the diagnosis can be made without further culture.

(4) Identification of strains To determine the type of Candida strains in the experiment, a fermentation test, an assimilation test must be performed, and the morphological characteristics of the colonies must be identified.

(5) pH measurement has important identification significance. If the pH is 4.5 and there are a large number of white blood cells in the smear, it is suggested that there is a mixed infection of trichomoniasis or bacterial vaginosis.

Diagnosis of simple vulvovaginal candidiasis

Typical cases are not difficult to diagnose. Based on the relevant medical history, the predisposing factors, symptoms, signs, and laboratory tests are easy to diagnose. A diagnosis can be made by finding spores or hyphae in the patient's secretions. Candida can be isolated from the vagina of some asymptomatic healthy women, but it may not cause vaginitis.

Simple vulvovaginal candidiasis treatment

Treatment principles: Actively remove incentives and standardize the application of antifungal drugs. Simple vulvovaginal candidiasis can be treated topically or orally. Pregnancy combined with vulvovaginal candidiasis is mainly local treatment, and oral azoles are prohibited. In general, couples do not need to be treated at the same time. Candida testing and treatment should be performed on symptomatic sexual partners to prevent repeated infections in women. Avoid sex during treatment.

Remove incentives

If there is diabetes, active treatment should be given. Timely stop broad-spectrum antibiotics, estrogen and corticosteroids. Change your underwear frequently. Used underwear, basins and towels should be scalded with boiling water.

2. Imidazoles

Imidazoles are a class of antifungal drugs that have developed rapidly in recent years. Most of them are applied topically, with a positive effect and few side effects, but a high recurrence rate. Among the imidazole drugs, clotrimazole and ticonazole are the first choice for clinical use, because of their significant efficacy and few side effects.

(1) Topical application Clotrimazole: Clotrimazole single vaginal administration is commonly used.

(2) Systemic use Ketoconazole: a broad-spectrum antifungal drug, which is characterized by good absorption in the gastrointestinal tract after oral administration. The effect on Candida is better than miconazole. Ketoconazole is easy to use and has a positive effect, but its side effects are significant, the most important being liver toxicity.

3.Triazoles

(1) Topical use Ticonazole: limited to topical application to treat candida vaginosis.

(2) Systemic use Itraconazole: Broad antifungal spectrum and fast absorption after oral administration. Common adverse reactions include gastrointestinal upset, headache, itching, and rash.

4. Polyenes

This is a class of antifungal drugs that were applied earlier in the clinic and are still widely used to this day. Among them, nystatin, clinectin, and mepatraxine have strong effects on Candida albicans.

5. Vaginal irrigation

Rinse the vulva and vagina with 3% sodium bicarbonate solution 1 to 2 times a day, or rinse the vagina and vulva with 2% soda water once a day, 10 times as a course of treatment. After vaginal flushing, vaginal medicine is usually placed.

Simple vulvovaginal candidiasis prevention

1. Wear cotton underwear and change it frequently. Separate towels and basins for cleaning the vulva.

2. Do not use sanitary pads except during menstrual periods; it is not advisable to wear tight pants and chemical fiber underwear.

3. Diabetics should control blood glucose within the normal range; do not abuse glucocorticoids and immune preparations; rational use of antibiotics.

4. Pay attention not to sexual life too often, pay attention to clean the vulva with warm water before and after sex.

5. The direction of wiping after bowel movement should be from front to back, so that candida in the anus will not be brought to the vagina.

6. Do not often use antibacterial external Jieyin medicine; do not wash the vagina at will.