Vaginal Yeast Infection, Vaginal Candidiasis: Causes, Symptoms, Diagnosis, Treatment and Prevention

What is Vaginal Yeast Infection?

Vaginal yeast infection (vaginal candidiasis) is mycosis of the mucous membrane of vagina, which occurs when it is colonized with strains of yeast-like Candida fungi. At the acute stage, reddening and swelling of the vulva are noted; burning sensation and itching in the vagina; profuse, curdy discharge from the genital tract; at the chronic stage – dryness and atrophy of the mucous membrane, excoriation, lichenization. Diagnosis is established according to the clinical picture. With vaginal yeast infection, systemic and local antimycotic drugs, multivitamins, immunostimulants are prescribed.

Vaginal Yeast Infection – Vaginal Thrush

Vaginal candidiasis or Vaginal thrush – one of the fungal infections, is caused by microscopic yeast-like fungi of the genus Candida (Candida albicans). All representatives of this genus are considered opportunistic. Microorganisms of the genus Candida are part of the normal microflora of the mouth, vagina and large intestine of most healthy people. The disease is caused not only by the presence of fungi of the genus Candida, but by their multiplication in large numbers and / or by the entry of more pathogenic strains of the fungus. Most often, candidiasis occurs with a decrease in general and local immunity. Candida infection is one of the most frequent in obstetrics and gynecology due to its widespread. Among vaginal infections, candidiasis ranks second after bacterial vaginosis. Vaginal candidiasis usually affects women of childbearing age (pregnant women – 2-3 times more often). Vaginal yeast infection can exist in the form of asymptomatic candidiasis, acute (up to 2 months) and chronic relapsing candidiasis (lasting more than 2 months).

What are Candidal Infections? Video.

In this video: symptoms, causes, diagnosis, treatment and pathology of Candidal Infections.

Causes of Vaginal Yeast Infection

A yeast infection is caused by the fungal organism Candida albicans. Candida albicans on the vaginal walls image.

What causes a vaginal yeast infection?

Vaginal candidiasis is caused by yeast-like fungi of the genus Candida, which live on the skin and mucous membranes of the mouth, the gastrointestinal tract, the external genital organs and the vagina of healthy women. The change in growth phases (pseudomycelia and blastospores) gives fungi the ability to survive in a wide temperature and acid range. The death of candida can be caused by boiling for 10-30 minutes, or by treatment with formalin, copper sulfate, carbolic and boric acid. The presence of the mannoprotein membrane and enzymes (proteinases and catalases) in fungi makes it easier to resist the immune system of the macroorganism.

The dominant pathogens of vaginal yeast infection (in 75-80% of cases) are strains of C. albicans, which have a large pathogenic potential. Diseases caused by other species (C.glabrata, C. tropicalis, C. krusei, C.parapsilosis) are more typical for certain ethnic groups (the Africans) and geographic regions (Mediterranean coast, Middle East), which is related to the specificity of the microbiocenosis of mucous membranes and skin, nutrition and living conditions.

As a rule, candidiasis is an endogenous infection that develops in conditions of asymptomatic candidiasis, usually vaginal, less often – on the mucosa of the mouth, intestines and skin. For example, the recurrent form of vaginal candidiasis is caused by the persistence of Candida in the intestine and the periodic penetration of the pathogen into vagina and its colonization.

Vaginal yeast infection occurs when there is disruption of this healthy balance, manifested by a decrease in the local immunity of the vagina. Local immunodeficiency (decreased activity of macrophages and lymphocytes) does not allow to block receptors and enzymes of fungi.

Vaginal candidiasis is usually not accompanied by a decrease in the level of lactobacilli and changes in the normal microflora of the vagina.

The development of vaginal yeast infection disrupts the balance of sex hormones during pregnancy, hormonal contraceptives, endocrine pathology. The effect of the oscillation of estrogens and progesterone on the vaginal mucosa is manifested by an increase in the concentration of glycogen in the epithelial cells, stimulation of their sensitivity to the candida fungi and more effective adhesion of fungi. Vaginal candidiasis more often accompanies various conditions associated with immunosuppression (HIV infection, diabetes, tuberculosis, hypovitaminosis, excessive use of antibiotics, corticosteroids, cytostatics, radiation therapy, etc.). Vaginal candidiasis can be associated with atopic manifestations (allergic rhinitis, food allergy).

Poor diet, the use of hygiene products (pads, tampons), wearing tight clothing-can be factors contributing to the development of vaginal candidiasis. There is a probability of transmission a candida infection to a newborn while passing through the birth canal of an infected woman; the sexual way of infection is possible. The risk of infection is higher with frequent oral-genital contacts.

Yeast Infection Symptoms in Women

  • Itching and burning in the intimate area of women.
  • Curdled vaginal discharge of white color.
  • Pain during or after sexual intercourse.
  • Painful urination.
  • Unpleasant smell.

At the acute stage of vaginal yeast infection, there are abundant thick white-gray discharge with a sour smell from vagina. The affected mucosa is edematous, hyperemic and prone to bleeding. In the acute phase, discharge are tightly attached to the mucosa and can hardly be cleaned; later easily removed from the genital tract. Itching and burning in the vulva is typical of vaginal candidiasis, which increase during menstruation period, physical activity, water procedures.

With chronic vaginal yeast infection, there may be no discharge, there is a slight hyperemia of the mucous membrane, dry erosions, lichenization and excoriation. The mucous membrane becomes flabby, atrophic; the entrance to the vagina narrows, hemorrhagic eruptions may appear.

Vaginal candidiasis usually extends to the external and internal genitalia, causing vulvovaginitis, cervicitis and urethritis.

Attention! The disease can cause interruption of pregnancy (spontaneous miscarriage, premature birth), development of endometritis in the postpartum period, infertility.

Diagnostics

Diagnosis of the disease is confirmed by the presence of clinical signs of infection and the presence of fungi on the vaginal mucosa. The fungal culture test should include not only the specific identification of the causative agent of the vaginal yeast infection, but also the sensitivity of the isolated strains to antifungal agents. Analyses are carried out according to the following scheme: using a constant standard seeding technique, rotating the tampon, sowing the material on a plate with the chromogenic substrate “CANDICHROM II”, whose hydrolysis enables the direct identification of Candida albicans (blue colonies).

The use of the chromogenic selective medium “CANDICHROM II” for primary seeding allows direct identification of the main causative agent of Candida albicans and other yeast fungi (the growth of bacteria is inhibited by a mixture of antibiotics). Other species of fungi of the genus Candida, as well as other pathogenic yeast fungi, can be reliably identified using the Elichrom FUNGI test system.

To determine the sensitivity to common antifungal drugs (fluconazole, itraconazole, amphotericin B, voriconazole, flucytosine (5-fluorocytosine)) the test system “FUNGIFAST AFG” is used. Given the likelihood of developing secondary resistance to azole preparations in Candida fungi, it is important to carry out sensitivity tests in the isolated strains.

Inspection of the cervix and vagina reveals flushing, swelling of the mucosa, gray-white curdy discharge in vaginal folds. When stained with Lugol’s solution, small-dotted inclusions and a vascular pattern appear. Discharge in vaginal candidiasis is found in about 76% of cases, itching – in 32%.

Microscopic examination of smears gives a picture of the round-oval, budding cells. As an artificial environment for feeding fungi, protozoa and bacteria, Saburo’s environment allows you to grow shiny white colonies of round shape. Species identification of fungi and determination of their sensitivity to drugs, complex PCR diagnostics and ELISA for pathogens of STIs are carried out. If necessary, the survey is supplemented by:

  • bacteriological examination of the urine and smear of the urethra on the microflora;
  • analysis of feces for dysbiosis;
  • blood sugar determination;
  • ultrasound of the pelvic organs, abdominal cavity and bladder.

Treatment

Complex treatment of vaginal yeast infection includes exposure to the causative agent – Candida fungi, elimination of provoking factors and therapy of concomitant pathology.

Some of the drugs are used topically (cream, vaginal tablets or suppositories), others are taken inside (tablets or capsules for ingestion).

There are different groups of antifungal drugs taken systemically and topically:

  • polyene antibiotics (nystatin, natamycin);
  • Imidazole, triazole, and thiazole antifungals (clotrimazole, ketoconazole, fluconazole, itraconazole).

Vaginal yeast infection treatment

Good results are shown after treatment with fluconazole, which has a wide range of fungistatic effects, which does not have a side effect on the synthesis of steroids and metabolism. The efficacy of a single oral high dose gives an advantage over other antifungals.

For the treatment of candidiasis, antifungal drugs such as voriconazole, amphotericin B, andechinocandins, miconazole, sertaconazole, Polyinax, Cyclopyrox and others are used.

Patients with very weak immunity and patients in a critical form are treated with intravenous fluconazole and caspofungin.

With a mild course of infection, topical drugs in the form of cream, vaginal suppositories and pills are used (miconazole, clotrimazole). With a chronic infection, the use of systemic antifungal agents is repeated by certain courses. Low-toxic forms of antimycotics are prescripted to pregnant women (natamycin, nifurate intravaginal) and children (nifuratel in applications and intravaginally, fluconazole orally).

Therapy can be supplemented by the using of disinfectant and anti-inflammatory drugs – solutions of borax in glycerin, potassium permanganate and silver nitrate in the form of syringing. With vaginal yeast infection of polymicrobial genesis, antimycotics with metronidazole are prescribed. Correction of immunity by immunostimulating agents is carried out, using of multivitamins is necessary. Full recovery is determined by the disappearance of clinical signs and a negative result of microbiological research.

List of Vaginal Yeast Infection Medications

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Drugs Used to Treat Vaginal Yeast Infection (Only Generics)
fluconazole
clotrimazole
nystatin
miconazole
terconazole
ketoconazole
itraconazole
tioconazole
Medications for Vaginal Yeast Infection (Brand Names)
Diflucan
Gyne-Lotrimin
Clotrimazole-3
Monistat 7-Day Combination Pack
Monistat 3-Day Combination Pack
Nystop
Mycostatin Topical
Sporanox
Nyamyc
Terazol
Pedi-Dri
Pediaderm AF
Terazol 7
Gynazole-1
Gyne-Lotrimin 3 Day
Terazol 3

Vaginal Yeast Infection Infographics

Vaginal Yeast Infection – Remedies, Symptoms, Causes and Treatment – Infographic

Vaginal Yeast Infection: Remedies, Symptoms, Causes and Treatment

Prevention

Prevention of vaginal candidiasis consists in eliminating the conditions for its development: limiting the intake of combined oral contraceptives, antibiotics, cytostatics; medicamentous correction of immunodeficiency, endocrinopathy and other concomitant pathology, preventive examination of women by a gynecologist.

A good way to prevent the growth of fungi is to eat yoghurts containing live lactic cultures, as well as the use of natural products with a good antifungal effect, such as garlic, propolis, berries and cowberry leaves, grapefruit juice and seeds, walnut leaves, tea tree oil.

There are a number of recommendations for the prevention of candidiasis (especially vaginal candidiasis):

  • Avoid uncontrolled sexual behavior.
  • Use condoms during intercourse. In case of allergic reaction to condoms made of latex, resort to products made of polyurethane.
  • Normalize weight – eat more fruits, vegetables, sour-milk products. Cut down on sugar and other refined carbohydrates, as they create a breeding ground for mushrooms. If you are sensitive to yeast-like or mold fungi, it is best to avoid products containing them: bread, sweet yeast pastries and moldy cheese.
  • Use cotton underwear. Synthetic fabrics do not provide sufficient air access to the skin. Increase in temperature and difficult evaporation of perspiration may trigger the infection, including candidiasis of the vagina.
  • The treatment with antibiotics should be provided only according to the doctor’s prescription. Patients should warn a doctor about their liability to candidiasis in advance, because antibiotics suppress the natural microflora and stimulate the development of yeast-like fungi.
  • Use only water-soluble lubricants.
  • Do not do syringing without necessity; it will help to avoid flushing out a healthy flora.

 

Dr. Jack Johnson, MD