VULVO-VAGINAL CANDIDIASIS

                                                                               INTRODUCTION

Inflammation of the vagina and vulva, usually evolving vaginal discharge and secondary external irritation candida albicans is the commonest cause of candidal vivo- vaginitis; candida glabrata has also been identified.

Candidal vaginitis is most common in:

  • Pregnancy
  • Patients with diabetes mellitus
  • Those on long term antibiotic therapy or oral contraceptive
  • Conditions associated with immuno supperssion corticosteroid use.
  • Usually not acquired through sexual intercourse because of the close proximity between the anus and female genitalia, re-infections may occur from the gastrointestinal tract.

Clinical features    

Up to 20% of women with the infection may be asymptomatic if symptoms occurred, they usually consist of vulval itching, soreness and a non-offensive vaginal discharge which may be curdy.

Clinical examination:

Vulval erythema (redness) or excoriations from scratching vulval oedema.

Erosions and crusting on the adjacent intertriginous skin.

Although treatment of sexual partners is not recommended, it may be considered for women who have recurrent infections.

A minority of male partners may have balanitis, which is characterized by erythema of the glans penis or inflammation of the glans penis foreskin (balanoposthitis).

Differential diagnoses

Other causes of vaginal discharge; see Gonorrhoea in women.

Complications

Emotional problems because of the recurrent nature of the infection, and dyspareunia very serious emotional problems in a non-sexually active person wrongly “accused” by parents, spouse or health care providers.

Investigations

Positive KOH examination

Culture of vaginal discharges

Treatment objectives

Cure the infection

Prevent recurrence

Drug therapy

Recommended regimen:

Clotrimazole 1% vaginal cream,

Insert 5 g at night as a single dose, may be repeated once if necessary.

Or:

Miconazole 2% intravaginal cream,

Insert 5 g applicator once daily for 10 – 14 days or twice daily for 7 days.

Or:

Clotrimazole 500 mg intravaginally as a single dose.

Or:

Fluconazole 150 mg orally, as a single dose.

Recommended topical regimen for balanoposthitis 

Clotrimazole 1% cream apply twice daily for 7 days.

Or:

Miconazole 2% cream twice daily for 7 days.

Notable adverse drug reactions, caution and contraindications

Fluconazole:

  • Caution in patients with renal impairment.
  • Avoid in pregnancy and breastfeeding.
  • Monitor liver function.
  • Discontinue if signs or symptoms of hepatic disease develop (risk of hepatic necrosis).
  • May cause nausea, abdominal discomfort, diarrhea, flatulence, headache, skin rash and stephen-Johnson syndrome.
  • Discontinue treatment or monitor closely if infection is severe.

 

 

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