A Family Doctor's Tale - CANDIDIASIS

DOC I HAVE YEAST INFECTION

candida fungus

Candidiasis is a very common infection in men and women usually spread by sexual intercourse. It presents as itchy rashes on the penis or in the vulva and vaginal area. It can also be caused by the wetness of the vulval and vaginal area due to sweat or menstrual bleeding followed by discharge.

Candidiasis is caused usually by the fungus Candida albicans.
Other Candida species or yeasts are also responsible.


What are the causes
1. Antibiotic therapy
2. Diabetes
3. Steroid or immunosuppressive drugs.


30% of patients do not have any symptoms.
The rest have symptoms like:


1. pruritus,
2.vaginal soreness,
3.dyspareunia,
4.external dysuria, and
5.abnormal white transparent vaginal dischargewoth heavy odour
About 75% of women will have at least one episode of Candidiasis, and 45% may have two or more episodes.


A diagnosis of Candida vaginitis is made clinically by the presence of:
1.external dysuria and
2.vulvar pruritis, pain, swelling, and redness.
3. vulvar edema, fissures, excoriations, or
4.thick curdy vaginal discharge.


The diagnosis is confirmed by
1) a Gram stain of vaginal discharge shows yeasts
2) a vaginal swab for culture shows the presence of a yeast species. Candida vaginitis is associated with a normal vaginal pH (<4.5).


Short-course intravaginal antifungal pessaries effectively treat uncomplicated Candidiasis .
The topically applied imidazole drugs are more effective than nystatin.
90% of patients are usually cured.


Oral Agent such as Fluconazole 150 mg may be given in  one tablet in single dose.


Patients should be instructed to return for follow-up visits only if symptoms persist.


Candidiasis is not usually acquired through sexual intercourse.
A minority of male sex partners might have balanitis, which is characterized by itchy red areas on the glans of the penis.
These men benefit from treatment with topical antifungal agents to relieve symptoms.


Topical agents usually do cause any systemic side effects although in some people local burning or irritation might occur.
Oral agents occasionally cause nausea, abdominal pain, and headache. Some abnormal elevations of liver enzymes may occur with treatment with the oral azoles.


A small percentage of women (<5%) has recurrences of Candidiasis 4-5 time in a year.
The majority of women with recurring Candidiasis have no apparent predisposing or underlying conditions.
Vaginal cultures should be obtained from these patients to confirm the clinical diagnosis and to identify unusual species, including nonalbicans species, particularly Candida glabrata Conventional antimycotic therapies are not as effective against these species as against C. albicans.


A longer duration of initial therapy is necessary to attempt mycologic remission before initiating a maintenance antifungal regimen.


Maintenance Regimens


Oral fluconazole (i.e., 100-mg, 150-mg, or 200-mg dose) weekly for 6 months is the first line of treatment. If this regimen is not feasible, some specialists recommend topical clotrimazole 200 mg twice a week, clotrimazole (500-mg dose vaginal suppositories once weekly), or other topical treatments used intermittently.


Suppressive maintenance antifungal therapies are effective in reducing RVVC. However, 30%–50% of women will have recurrent disease after maintenance therapy is discontinued. Routine treatment of sex partners is controversial. C. albicans azole resistance is rare in vaginal isolates, and susceptibility testing is usually not warranted for individual treatment guidance.