Chronic vulvovaginal candidiasis. What is vulvovaginal candidiasis and how to cure it? Causes of genital fungus

Vulvovaginal candidiasis is a disease of the genital tract caused by the influence of fungi of the Candida species. An infectious lesion of the vagina is diagnosed in 45% of women who applied with inflammatory symptoms.

What is vulvovaginal candidiasis

The mucous membranes of the vagina are a protective barrier designed to keep pathogens on their surface layer and prevent their further spread. These properties are dependent on the health of the microflora of the genital tract. At a normal level of lactobacilli, infectious pathogens that have fallen on the mucous membrane cannot multiply and cause the development of inflammatory processes. In violation of microbiocenosis, pathogenic microorganisms begin to become more active, causing the development of the disease.

Candida fungi live on the skin and mucous membranes of healthy people and are not dangerous if the immune system is functioning normally.

The risk of inflammation in the vagina increases in women suffering from chronic pathologies that weaken the body's defenses.

Invading the mucous membranes of the genital organs, the fungal infection multiplies rapidly and causes severe discomfort, seriously impairing the quality of life of the patient.

Forms of vulvovaginal candidiasis

Vulvovaginal candidiasis can occur in three forms, the development of which depends on the microflora of the genital mucosa and general health:

1. Asymptomatic carrier. The patient does not show any signs of a fungal infection. For the development of such a condition, a small increase in the number of microorganisms and the presence of a significant level of beneficial lactobacilli in the microflora are sufficient.
2. The true form of candidiasis. Accompanied by severe clinical signs resembling vulvovaginitis. On the mucous membranes, a lot of fungi are detected in the presence of lactobacilli.
3. Candidiasis, accompanied by symptoms of dysbacteriosis. Laboratory tests show the prevalence of fungal infection over beneficial microflora. Lactobacilli are contained in a minimal amount.

The course of the disease can be:

• acute, which is characterized by a single occurrence and a duration of about a month;
• chronic, accompanied by relapses up to 3-4 times a year and more often;
• persistent, having signs of fading of symptoms after treatment and the development of exacerbations after a while.

Causes

Infectious inflammation of the vagina is provoked by yeast-like fungi that affect the mucous membranes. During reproduction, these microorganisms begin to adhere to each other and form pseudomycelia, which causes dense attachment to tissues and the formation of numerous focal colonies.

The vulvovaginal type of candidiasis develops under the influence of factors such as:

1. Dysbacteriosis of the vagina. This condition is accompanied by a decrease in the number of beneficial bacteria and a change in the acidity of the environment.
2. Decreased immunity. Protective forces are weakened under the influence of various factors: the presence of inflammatory processes in the body, chronic pathologies, the presence of frequent stressful situations, excessive physical exertion.
3. Hormonal disorders. The epithelium of the vagina changes its structure when exposed to estrogens. They have a direct effect on the synthesis of glycogen, which is necessary for the reproduction of lactobacilli. With a decrease in hormone levels, the number of beneficial microorganisms decreases.
   

   Some women develop thrush while taking oral contraceptives.

4. Childhood and adolescence. The manifestation of candidiasis in girls is often found due to low local immunity. In adolescence, a fungal infection is activated due to an imbalance of hormones caused by a lack of rhythm in the work of the ovaries.
5. Vaginosis of a bacterial nature. The risk of reproduction of candida increases in the presence of an inflammatory process in the genital organs caused by pathogenic microorganisms.

Diagnostics

The detection of vulvovaginal candidiasis is not particularly difficult with the current level of laboratory equipment. Fungi are detected during smear studies on flora. In some cases, the use of microscopic, bacteriological methods, polymerase chain reaction is required.

A gynecologist can suspect the presence of thrush during a colposcopy. If signs of the presence of candida are detected, the patient is assigned to study biological materials using a specific test. Colposcopy reveals inflammatory changes in epithelial tissues, the presence of iodine-negative areas of different sizes. In the course of an extended study using Lugol's solution, a large number of inclusions in the form of small dots are found.

Signs and symptoms of the disease

A fungal disease caused by candida is accompanied by two main symptoms: severe itching and leucorrhoea, which have a characteristic appearance. The degree of manifestation of other symptoms depends on the severity of the pathological process in the vagina, dysbacteriosis and the state of local immunity.

Women suffering from endocrine disease and hormonal imbalance are prone to severe candidiasis.

Fungal infection affects not only the vagina, but also the vulva, the skin of the pubis. The manifestations of thrush can be seen in the photo in our article.

These areas begin to itch unbearably. Often, patients begin to involuntarily comb the infected areas, which causes injury to the skin and mucous membranes, and the appearance of rashes. The persistent sensation of itching leads to the appearance of psycho-emotional disorders: irritability increases, problems with sleep arise. Intimate contacts also cause discomfort and are minimized.

Allocations in the vulvovaginal form of candidiasis look like flakes and resemble cottage cheese. With the introduction of candida into the urinary tract, a dysuric symptom develops. Fungi are able to interact with another type of pathogenic microorganisms, which allows Candida to penetrate deeper into the tissues of the genital organs.

Acute candidiasis is manifested by severe redness of the vagina, vulva, cervix. Puffiness is also observed, foci with a white coating, upon removal of which bleeding develops.

A fungal infection in pregnant women is often diagnosed at the beginning of the first trimester, which is associated with serious changes in the hormonal background. The symptomatology is erased, and the disease is usually detected in the course of laboratory tests.

A child suffering from candidiasis may have signs of allergies, a bacterial infection of the genitals. First of all, fungi affect the vulva, and then the mucous membranes of the vagina.

Therapy for vulvovaginal candidiasis

The effectiveness of therapy for vulvovaginal candidiasis depends on the timeliness of its detection. When treating a fungal infection in the first 60 days, it is possible to completely eliminate the symptoms of the disease and prevent the development of relapses. In the acute form of candidiasis, local preparations are used in the form of suppositories containing fungicidal substances (ketoconazole, miconazole). Ointments and creams have a pronounced therapeutic effect. Since acute candidiasis is accompanied by severe itching, patients are prescribed painkillers or antihistamines and medications to stimulate the immune system.

Medicines for topical use are ineffective in chronic vulvovaginal candidiasis. In this case, women are prescribed oral tablets with antifungal action (fluconazole, nystatin).

To evaluate the effectiveness of therapy allow laboratory tests. They are carried out once in acute disease and three times in chronic. After the destruction of the pathogen, the doctor prescribes a prophylactic antifungal course with drugs containing lactobacilli (acylact, lactagel). Means for topical use help to restore the normal level of the microflora of the vagina.

Treatment during pregnancy

Pregnancy is a contraindication for the use of many antifungal drugs.

Women during childbearing are prescribed medications with no teratogenic effect. At the same time, drugs should quickly and fully ensure the destruction of the infection.

With vulvovaginal candidiasis, oral fungicides are not prescribed to pregnant women. For topical use, clotrimazole, terconazole, natamycin are used. Vaginal suppositories and gels with imidazole are prescribed only in the second trimester. Therapy for the acute form of the disease is 7 days. With relapses of chronic vulvovaginal candidiasis, the duration of treatment is 2 weeks. If necessary, a supportive course is drawn up for women after childbirth, which is signed for six months. To prevent relapse, suppositories with natamycin are prescribed, tablets for local use with clotrimazole.

After 14 weeks of pregnancy, the doctor may prescribe combined medications:

• terzhinan;
• klion d.

Inflammatory processes in the genitals are treated with betadine, hexicon, fluomizin.

Treatment of the chronic form of the disease

In the chronic form of vulvovaginal candidiasis, patients are prescribed a systemic antimycotic drug itraconazole, which must be taken for 3 days. As a local therapy, drugs from the azole group are used for 2 weeks.

Fluconazole is used to prevent exacerbations of the disease. It must be taken once a month on the first day of menstrual bleeding. The course is - 6 months. Patients are shown the use of vaginal suppositories every 7 days for six months. To evaluate the effectiveness of therapy, laboratory tests of smears are carried out.

Chronic candidiasis requires exclusion from the diet of sweet foods and simple carbohydrates. For the duration of treatment, the administration of a medication with an estrogen-progestogenic effect, glucocorticosteroids, is canceled.

Complications and consequences

The lack of competent therapy or attempts to self-treat vulvovaginal candidiasis with drugs and folk remedies can lead to various complications:

1. Deterioration of the quality of sexual life. With exacerbations and manifestations of a fungal infection after sexual intercourse, women experience pain in the lower abdomen, itching of the mucous membranes of the vulva and vagina. Over time, there is a decrease in libido, the development of psychological problems.
2. Infertility. With the penetration and activation of candida in the genital organs, in most cases, inflammatory processes occur, the lack of treatment of which leads to the inability to become pregnant naturally.
3. miscarriages. Fungal infection can lead to the development of choriamnionitis and premature birth.
4. Infection of the child when passing through the maternal pathways. Symptoms appear in infants in the form of damage to the mucous membranes of the eyes, oral cavity, and genital organs. A serious complication in newborns is a fungal infection of the esophagus.

To prevent the development of candidiasis, it is important to observe the rules of intimate hygiene, strengthen the immune system and refuse to use confectionery and flour products.

An excellent means of prevention is the introduction of fermented milk products into the daily menu. After a long course of antibiotic therapy, it is necessary to drink probiotic preparations. When the first signs of vulvovaginal candidiasis appear, you should consult a gynecologist. Timely treatment helps to avoid the negative consequences of a fungal infection.

Vulvovaginal candidiasis is a common, often infectious disease that occurs in women of different ages. This disease is most often diagnosed in young girls and women of childbearing age. Otherwise, this disease can be called thrush, vulvovaginal mycosis, genital fungus. This pathology is very widespread, diagnosed in about 45% of women. Difficulties in treatment arise due to the fact that such a disease is prone to relapses and a chronic course. This picture is formed due to the root cause of thrush. The causative agents of the disease are yeast-like pathogenic fungi, which are constantly present in different quantities in the body. There are more than 100 different types of them, so it is important to correctly select the medicine in order to have an effect. In normal times, Candida fungi do not show aggressiveness and excessive activity, they are suppressed by beneficial microflora. But if favorable conditions are created, the colonies of the fungus begin to grow rapidly, affecting the surfaces of the mucous membranes, internal organs, and skin. A disease left untreated can quickly turn into a severe and chronic form, leading to a lot of unpleasant consequences.

Symptoms of different forms of fungal disease

candidiasis under the microscope

There are three main forms of vulvovaginal candidiasis. The mild form begins abruptly, the basic symptoms are very pronounced, but under the influence of drugs, the disease disappears quickly enough. The acute form of thrush occurs when the infection does not respond to treatment. Some additional symptoms may be added. The chronic form of genital fungus is diagnosed in cases where the disease constantly returns (more than four times in one year), its symptoms are significantly pronounced, and the therapy does not give a full result. A similar picture is observed in approximately 5% of all patients with candidal pathology.

Typical symptoms

Foci of infection are fixed in the intimate area. The mucous membranes, vagina, vulva, organs of the genitourinary system are affected. Symptoms differ in that they are pronounced, increasing with the course of the course of the disease. In rare cases, the disease can have a so-called latent form, when external signs are not visible, and the patient is diagnosed by chance after a routine examination.

The following symptoms may accompany candidiasis of the vulva and vagina:

As a rule, signs of fungal pathology are especially noticeable before or after menstruation, as well as during pregnancy. They intensify in the evening and at night, after taking a warm shower or bath. The condition worsens after intimacy, long walking or after playing sports.

What provokes the development of a painful condition

The root cause of the occurrence of thrush are fungi that exhibit aggressive activity. A variety of external and internal factors can provoke this. Despite the fact that men do not often experience obvious manifestations of candidiasis, they can act as carriers of active fungi. After unprotected sexual contact, infection occurs, and then the woman is faced with the development of the disease in herself. You can also get infected through personal hygiene items. During pregnancy, if the pathology is not treated in any way, the condition is not corrected, there is a threat of infection of the newborn.

Common Causes

The risk of developing fungal pathology can be increased by regular and severe stress, depression, improper diet and starvation, lack of vitamins and mineral microelements in the body.

Risks and Complications

With prolonged neglect of symptoms and general condition, the risks of complications increase. In this case, there is not only the threat of transition of candidiasis into a chronic and sluggish form, which will constantly accompany a woman.

The main complications are:

Therapy Options

The treatment plan is developed individually. Treatment is based on the results of the diagnosis, which includes examination and questioning of the patient, procedures and necessary tests. When selecting drugs and methods of therapy, complaints, the presence of additional diseases and possible allergic reactions, and general health are taken into account. An important role is played by data on the female microflora and which of the subspecies of harmful yeast-like fungi is active. When a candidal type of disease is noted in pregnant women, only a professional doctor can decide exactly which methods of correction to apply. Because of all these nuances, self-treatment and the choice of remedies against thrush should not be carried out. Otherwise, the situation can only be aggravated without getting any positive effect.

Medicines

Vulvovaginitis is treated with antifungal drugs (for example, Nystatin), imidazole agents (Bifonazole, Fluconazole, Lamisil), various topical medications (Decamine, Betadine). Iodine preparations and combined drugs (eg, Pimafucort) may be used.

Cream Mycospor containing Bifonazole

The following medications are especially often prescribed to patients:

• Itraconazole.
• Butoconazole.
• Miconazole and others.

Non-drug correction options

Along with medications, traditional medicine can also be used. It is based on the selection of the most effective gynecological fees, medicinal flowers and. It may be useful to use soda solutions.

Traditional medicine acts as a so-called maintenance therapy. With the help of decoctions and infusions, washing is carried out, compresses, lotions, gauze swabs, and douching are made. However, the use of such funds should be carried out exclusively as prescribed by a medical specialist. It is important to carefully monitor your well-being so that there is no unpleasant allergic reaction to herbs.

Herbs - an effective remedy for candidiasis

The effectiveness of treatment will depend not only on the correct selection of the necessary funds. Correction of life, treatment of concomitant diseases, accurate identification of the causes provoking outbreaks of fungal pathology are important.

1. change the diet, removing sweet, carbohydrate foods from the menu to the maximum;
2. refrain from taking antibiotics and other potent drugs, especially those that suppress the activity of the immune system;
3. strengthen immunity through hardening, water procedures, sports, active supplements and vitamins;
4. to refuse sexual intercourse during treatment, from unprotected sex at other times;
5. avoid drinking alcohol, get rid of bad habits;
6. minimize stress in life, improve daily routine;
7. refuse oral contraceptives containing estrogen;
8. change your wardrobe, give up synthetic underwear;
9. improve daily intimate hygiene, refrain from using untested products;
10. timely treat any diseases, inflammatory processes, maintain general well-being in the norm;
11. avoid overheating and hypothermia, any negative effects on the immune system.

It will also be important to implement preventive measures that will prevent the recurrence of this fungal pathology. They build on the additional tips above. In addition, after consulting with your doctor, you can take preventive medications from time to time.

Among female genital infections, vulvovaginal candidiasis occupies one of the first places. Almost 90% of women face thrush, as it is popularly called. Most, having been ill once, forever forget about such a diagnosis. But almost 20% have recurrent thrush, which is activated from time to time. Over the years, resistance to most drugs develops, and it becomes more difficult to cure candidiasis.

This disease usually occurs in women of childbearing age. But vulvar candidiasis also affects little girls - with weakened immunity, poor hygiene, or infection from the mother. Small patients are more difficult to treat because topical treatment is not always possible, and topical creams very rarely give the desired effect.

What will the article tell you?

What is vulvovaginal candidiasis?

This is a fungal disease that affects the mucosa of the vulva and vagina. The causative agent is fungi of the genus Candida, most often (90%) - Candida albicans. Other types of Candida fungi can also become the cause of the disease, but more often they join an existing infection in the presence of chronic thrush or other systemic diseases that weaken the immune system.

If, according to the results of the examination, you have identified Candida fungi in small quantities, there is no reason to panic. They are conditionally pathogenic flora, live in the genital tract of 40% of women and do not provoke the disease. But with the weakening of the body's defenses, against the background of hormonal changes, other diseases, the infection can go into the active stage.

Often, candidiasis occurs against the background of other local infections - STDs, vaginal dysbiosis, or itself causes changes in the vaginal microflora. In this case, complex treatment is required. It is not enough just to take an antifungal drug: during treatment, you also need to monitor the restoration and formation of the normal composition of the microflora - this will help to avoid relapses.

Forms of the disease

Depending on the number of fungi detected during the examination, and the presence of symptoms, there are:

• carrying a fungal infection, often asymptomatic;
• acute candidiasis of the vulva and vagina(inflammatory process, during which the symptoms of the disease are clearly manifested);
• chronic form(develops as a result of improper treatment or its complete absence, as well as against the background of a weakened immune system).

The reasons

The main cause of thrush is a weak immune system, which is not able to independently cope with the reproduction of conditionally pathogenic flora. Also lead to the development of vulvovaginal candidiasis:

• transmission of infection from a sick person - at home, sexually, from mother to child during childbirth or in case of non-compliance with the rules of personal hygiene;
• pregnancy, against which the immune system weakens;
• malnutrition, saturated with carbohydrates and sugars;
• wearing tight and synthetic underwear;
• inflammatory processes of female reproductive organs;
• non-compliance with personal hygiene, especially during menstruation;
• long-term antibiotic treatment;
• hormonal imbalance, taking hormonal drugs, including high-dose oral contraceptives;
• endocrine disorders, etc.

Vulvovaginal candidiasis: symptoms indicating a disease

The intensity of symptoms depends on the number of pathogens and the spread of the infection. And young girls and girls, thrush is often localized on the external genitalia. In women, the inflammatory process can capture the cervix.

In women of childbearing age, signs of the disease do not always appear immediately after the activation of the pathogen: they may appear in the last days of the monthly cycle or with the onset of menstruation.

Thrush symptoms:

1. Copious white curdled discharge with a sour smell;
2. Redness of the mucous membrane;
3. Itching and burning, which are worse at night;
4. With a strong lesion on the mucosa, wounds and cracks can occur.

Sometimes the infection can enter the urethra, causing candidal urethritis or cystitis. In this case, there is a burning sensation and pain during urination, the temperature may rise slightly.

Who is at risk?

In a healthy body, Candida fungi are present in small quantities. Even with contact with an infected person, the risk of developing the disease is minimal.

The appearance of symptoms of thrush is a sure sign of weakened immunity, the presence of intestinal dysbacteriosis, when the body becomes vulnerable to infections. That is why candidiasis often develops against the background of existing infections and their treatment.

The following are at particular risk of developing thrush:

• little girls, whose immune systems are just developing, are learning to recognize pathogenic microorganisms and fight them;
• teenage girls who experience hormonal changes, a monthly cycle is established;
• pregnant women;
• patients with chronic inflammatory diseases of the uterus and ovaries;
• women with diabetes and other endocrine disorders;
• patients with chronic infections;
• who have had an STD;
• patients with intrauterine devices;
• women who have multiple sexual partners/frequently change partners;
• patients with HIV, AIDS, immunodeficiency states.

These groups need to be more careful about hygiene and adhere to proper nutrition.

Diagnostics

The gynecologist makes this diagnosis on the basis of a comprehensive examination. When viewed on the mucosa of the vulva and vagina, a white coating is noticeable. A urogenital swab helps confirm the presence of a fungal infection and determine the exact type of Candida fungi. This allows for more effective treatment. Also, the results of the smear help to assess the overall composition of the vaginal microflora, prescribe additional treatment, because candidiasis and vulvovaginitis of a bacterial nature often occur simultaneously.

Treatment

In case of candidiasis, fungicidal drugs are prescribed (suppressing the reproduction of the fungus), as well as drugs to normalize the microflora, strengthen the immune system, and treat concomitant diseases. If the infection is chronic, a positive effect can be achieved with the use of several groups of drugs.

Treatment of thrush in women of childbearing age

Simultaneously with local treatment (suppositories, ointments and creams), preparations for oral administration are prescribed - since Candida fungi are often localized in the intestine. For the treatment of patients with thrush, several groups of antifungal drugs are used:

• preparations of the imidazole series (clotrimazole, miconazole and products based on them);
• triazoles (fluconazole, itraconazole);
• polyene medicines (pimafucin, nystatin);
• combined (terzhinan, polygynax, makmiror).

For a complex action, local and internal medications are prescribed from different groups. You should not choose drugs on your own - they should be prescribed by a doctor after determining the specific type of fungi. Also, ointments and creams that are used to treat skin fungus should not be used to treat vulvovaginal candidiasis.

In parallel, probiotics and vitamin complexes are taken to improve the intestinal and vaginal microflora. With a severe infection, interferon preparations may be required to support and activate the immune system.

It is important to adhere to the period of treatment set by the doctor, not to cancel it yourself: the subsidence of symptoms does not mean that the infection has been completely overcome, but the risk of developing a chronic form increases.

For effective treatment, along with medication, a woman is recommended diet and sexual rest. You should not plan pregnancy during or immediately after treatment for thrush: it is better to wait a few weeks until the drugs are completely eliminated from the body.

In the treatment of acute candidiasis, one course is usually sufficient. In the chronic form, after the main therapy, the patient is prescribed periodic administration of antifungal drugs for several months, and control tests in the first three cycles.

During pregnancy

Many antifungal drugs can adversely affect the formation of the fetus, especially in the first trimester. Often, doctors suggest that a woman wait with treatment, and be treated comprehensively after childbirth. But if the symptoms are pronounced, cause concern, and if there is a high risk of infection of the child during childbirth, the doctor prescribes the most benign local treatment.

Pregnant women can use vaginal suppositories, tablets and ointments. Local funds are not absorbed by the blood, and do not harm the fetus. However, the drug should be selected by the doctor, based on the general health of the patient, the characteristics of the course of pregnancy. You should not choose the drug yourself: not all local remedies are allowed during pregnancy.

If possible, it is worth refraining from topical treatment in the first trimester, especially if there is a risk of miscarriage. Starting from the second trimester, ointments and suppositories can be used.

Sometimes a doctor may recommend taking antifungal medications a few days before the expected birth to prevent infection of the baby during passage through the birth canal. At this time, the baby's organs have already formed, and the effect of medications is not as dangerous as the risk of infection.

Treatment of vulvovaginal candidiasis in young children

In girls, this disease can occur when:

• infection from the mother, including through unwashed hands, using one towel;
• the presence of inflammatory processes of the pelvic organs;
• intestinal dysbacteriosis;
• long-term treatment with antibiotics;
• weakened immunity, as evidenced by frequent colds;
• the use of a large number of sweets, malnutrition.

If a thrush is found in a girl, it must be treated. Otherwise, candidiasis can become chronic, cause damage to the bladder and intestines, disruption of the reproductive organs, and fusion of the labia.

After examination and tests, a pediatric gynecologist may prescribe:

• therapeutic baths using decoctions and infusions of herbs;
• antifungal ointments and creams;
• diet with restriction of sweet and dairy products;
• strengthening immunity.

Diet for vaginal candidiasis

In the treatment of thrush (as well as in order to prevent recurrence in chronic infections), it is important to adhere to a balanced diet. Diet plays an important role, since a large amount of flour and sweets is a breeding ground for fungi. Be sure to use:

1. Foods rich in fiber - fresh vegetables, fruits;
2. Kashi (boiled in water);
3. Lean meat and fish;
4. Cottage cheese and natural homemade yoghurts without sugar;
5. Vegetable and butter.

What should be excluded from the diet:

1. Pastries, white bread;
2. Sugar and candy;
3. Shop juices, sweet drinks;
4. Alcohol;
5. Smoked meats and pickles;
6. Coffee and strong tea;
7. Milk, kefir, fermented milk products;
8. Cheeses with mold;
9. Store-bought sauces, vinegar.

Prevention

To prevent the development of a fungal infection, you need:

• adhere to the rules of personal hygiene, use a personal towel, do not wear someone else's underwear;
• wear underwear made from natural fabrics, free;
• timely change feminine hygiene products, when using panty liners, change them every 2-3 hours;
• eat properly, limit the use of sweet and starchy foods;
• control weight;
• support the immune system, monitor the general level of health, conduct hardening.

It is also important to undergo a preventive examination by a gynecologist in a timely manner, especially when symptoms of the disease appear.

Vulvovaginal candidiasis (VVC)- this is an inflammation of the mucous membrane of the vulva, vagina, urethra, perineum by fungi of the genus Candida.

SYNONYMS FOR CANDIDIOSIS

Urogenital candidiasis, vulvovaginal mycosis, urogenital mycosis, thrush, genital fungus.

ICD-10 CODE B37 Candidiasis. B37.3 Candidiasis of the vulva and vagina. B37.4 Candidiasis of other urogenital sites.

EPIDEMIOLOGY OF VULVOVAGINAL CANDIDIOSIS

Vulvovaginal candidiasis- one of the most frequent urogenital infections. The prevalence of thrush among women of reproductive age is 25-40%. Vulvovaginal candidiasis is second only to BV. More than 2/3 of the female population of the planet once in a lifetime suffered vulvovaginal candidiasis. The most common recurrent vaginal candidiasis. As early as 3–6 weeks after the cure of candidiasis, 10–33% of patients in vaginal smear studies note the presence of a Candida albicans culture.

PREVENTION OF CANDIDIOSIS

Rational antibiotic therapy, timely correction of the immune system, regulation of carbohydrate metabolism, the right choice of hormonal contraception, personal hygiene are important and effective preventive measures.

SCREENING

Patients with complaints of cheesy vaginal discharge, itching, burning, dyspareunia, all pregnant women at registration and during the period of dynamic observation are subject to examination.

CLASSIFICATION OF VULVOVAGINAL CANDIDIOSIS

Allocate:

• acute vulvovaginal candidiasis;
• recurrent (chronic) vulvovaginal candidiasis;

Candidiasis is not a generally recognized pathology due to the presence of fungi in healthy women.

ETIOLOGY OF VULVOVAGINAL CANDIDIOSIS

The most common causative agent of vulvovaginal candidiasis is fungi of the genus Candida, which includes C. albicans, C. pseudotropicalis, C. glabrata, C. krusei, C. parapsilosis, and others. In addition, the frequency of fungal infections caused by fungi of other species is increasing: Torulopsis glabrata , Saccharomyces cerevisae, etc. Fungi most often affect the vagina, vulva, skin of the perianal region, and urethra. The disease - urogenital candidiasis, proceeds according to the type of vulvovaginitis or dermatitis of the vulva.

PATHOGENESIS OF VULVOVAGINAL CANDIDIOSIS

Risk factors:

• wearing synthetic, tight-fitting underwear;
• sanitary napkin;
• oral sex;
• diabetes;
• pregnancy;
• taking broad-spectrum antibiotics;
• high-dose oral contraceptives;
• treatment with steroid drugs;
• diaphragms, IUDs, spermicides.

Along with known risk factors such as pregnancy, high-dose hormonal contraceptives, and antibiotics, the main cause of vulvovaginal candidiasis is a weakened immune defense. Women suffering from acute or chronic vaginal candidiasis, on average, have fewer T-lymphocytes, T-helpers and B-lymphocytes, as well as a smaller number of T-killers, compared with healthy women.

CLINICAL PICTURE OF VULVOVAGINAL CANDIDIOSIS

The clinical picture is characterized by:

• heavy or moderate cheesy vaginal discharge;
• itching and burning in the vulva;
• increased itching in the afternoon, during sleep, after water procedures, sexual intercourse, long walking, during menstruation;
• dyspareunia;
• dysuric symptoms.

In non-pregnant women, complaints prevail over the clinical symptoms of the disease. Patients complain of itching and burning in the vulva, gray-white "curdled" discharge from the genital tract and urethra, urination disorder. During a gynecological examination, edema of the vulva, hyperemia and bleeding of the mucous membranes are noted, on the skin there are areas of hyperemia and maceration. A characteristic sign of the disease is gray-white deposits on the mucous membranes, which are difficult to separate with a spatula, areas of pronounced hyperemia under the plaque.

Complications of vulvovaginal candidiasis:

• vaginal stenosis;
• increased risk of pelvic infections;
• recurrent infections of the urinary system;
• miscarriage;
• the birth of small children;
• chorioamnionitis;
• premature rupture of membranes;
• premature birth.

DIAGNOSIS OF VULVOVAGINAL CANDIDIOSIS

The diagnosis is made by evaluating the history, complaints, clinical manifestations and laboratory results. In addition to express methods (light microscopy of native preparations, Gram smear microscopy stained with accredino-orange, luminescent microscopy), culture methods with selective media (Saburo) and immunofluorescent methods are used. To suspect a candidal infection, a combination of three of these symptoms is necessary:

• curdled discharge;
• local signs of inflammation;
• the presence of spores or mycelium in smears.

Criteria for the diagnosis of vulvovaginal candidiasis:

• vaginal pH 4.0–4.5;
• no smell (in the smell test in the mirror and aminotest);
• detection of yeast-like fungi or pseudohyphae in a wet preparation (positive result 40-60%);
• detection of yeast-like fungi or pseudohyphae in a Gram smear (positive result up to 65%);
• detection of yeast-like fungi in the cultural study of the material (if symptoms from the vulva prevail, then the material must be taken with a swab in this area).

The procedure for diagnosing urogenital candidiasis

1. Smear microscopy.
2. Cultural method.
3. Serological reactions of RA, RSK, RP.
4. Enzyme immunoassay (ELISA).
5. Polymerase chain reaction (PCR).

PHYSICAL EXAMINATION

A gynecological examination reveals a large amount of white curdled discharge, hyperemia and swelling of the mucous membranes.

LABORATORY RESEARCH

• Microbiological diagnostics: ♦ smear microscopy of vaginal discharge (native and Gram-stained preparations); ♦ cultural method (determines the amount, genus and species sensitivity to antifungal drugs, as well as the nature and degree of colonization by other microorganisms).
• Serological methods (RSK).
• Immunofluorescent diagnostics (CandidaSure).
• Express methods (do not allow to identify the accompanying flora).
• Immunological research.

It has been established that mycoses are not sexually transmitted, however, it has been confirmed that this disease is associated with the nature of sexual contacts (anal-vaginal, orogenital, etc.). Candidiasis vulvovaginitis is not sexually transmitted, even though identical strains of fungi are isolated from partners. Treatment of sexual partners is necessary only in case of development of candidal balanoposthitis.

TREATMENT OF VULVOVAGINAL CANDIDIOSIS

Conditions for effective treatment of vulvovaginal candidiasis:

• the abolition of estrogen-progestogen drugs;
• withdrawal of glucocorticoids;
• cancellation of antibiotics;
• rejection of bad habits;
• carbohydrate restriction, diet;
• local therapy in uncomplicated cases;
• combined local and systemic therapy for recurrent VVC.

Primary cases of treatment of acute vulvovaginal candidiasis, as a rule, do not cause difficulties. The use of antifungal agents, mainly azoles, is effective. It is much more difficult to treat recurrent vulvovaginal candidiasis. Treatment requires the use of not only antifungal drugs, but also a complex of auxiliary therapy. Very often, treatment is unsuccessful, despite the use of many antifungal drugs. The HIV epidemic makes this problem even more urgent. Another urgent problem is the combination of infection with gastrointestinal lesions.

Treatment of acute vulvovaginal candidiasis.

• Butoconazole: 2% vaginal cream 5 g once.
• Ketoconazole: vaginal suppositories 400 mg (1 suppository) 3-5 days.
• Fluconazole: 150 mg orally as a single dose.
• Itraconazole: 200 mg orally twice a day for 3 days.
• Sertaconazole 300 mg (1 vaginal suppository) once.
• Clotrimazole: 100 mg (1 vaginal tablet) for 7 days or 200 mg (2 vaginal tablets) for 3 days or 500 mg (1 vaginal tablet) once or 1% cream 5 g intravaginally for 7-14 days.
• Miconazole: vaginal suppositories 100 mg (1 suppository) at night for 7 days or 200 mg (1 suppository) for 3 days.
• Nystatin: vaginal tablets 100,000 IU (1 suppository) daily for 14 days.
• Thioconazole 6.5% ointment 5 g intravaginally once

Despite the high efficiency of traditional local therapy, many patients experience relapses after 1–3 months. Many factors contribute to this. For example, broad-spectrum antibiotics, especially with prolonged use, change the normal vaginal microflora, resulting in the development of BV. Oral contraceptives increase the risk of candidiasis in the same way as pregnancy: high estrogen levels cause high levels of glycogen, favorable for the growth of fungi of the genus Candida. In addition, estrogens enhance adhesion to the vaginal epithelium and its colonization by fungi. In patients with diabetes, the risk of vaginal candidiasis is higher due to increased levels of glycogen in the vaginal epithelium and reduced immunity. An increase in the number of Candida species such as C. pseudotropicalis, C. glabrata, C. parapsilosis is another reason for the increase in the number of relapses.

These species are less sensitive to traditional topical treatments than C. albicans. An increase in their clinical significance is facilitated by the completion of local treatment by patients before the onset of a cure. The insufficiency of traditional therapy for the eradication of such pathogens, the widespread use of short courses of topical imidazoles increases the risk of developing resistance. If in acute forms only local therapy is possible, then in chronic forms a combination of local, systemic and anti-relapse therapy is mandatory.

Therapy for chronic vulvovaginal candidiasis:

• a systemic antimycotic (itraconazole 200 mg orally twice a day for 3 days or fluconazole 150 mg for 3 days) and
• local therapy with azole drugs (on average, for 14 days).

Prevention of recurrence of vulvovaginal candidiasis:

• systemic antimycotic (itraconazole 200 mg orally or fluconazole 150 mg on the first day of menstruation for 6 months);
• therapy with local preparations once a week for 6 months.

Medicines used to treat genital candidiasis*

Imidazole preparations:
♦ ketoconazole (nizoral) - inhibits ergosterol biosynthesis in the fungus cell. Apply 400 mg / day, for 5 days;
♦ clotrimazole (kanesten) - inhibits the synthesis of nucleic acids, lipids, polysaccharides in the fungal cell. Apply in the form of vaginal tablets, 200-500 mg or 1-2% cream for 6 days;
♦ miconazole - 250 mg, 4 times / day, 10-14 days. Vaginal cream or vaginal suppositories (400 mg) daily for 3-6 days;
♦ bifonazole - 1% cream, 1 time / day. at night, 2-4 weeks;
♦ ginezol 100 or 400 mg: 1 suppository per vaginum;
♦ ginalgin - 1 vaginal suppository at night, 10 days;
♦ isoconazole (travogen) - vaginal balls, 3-5 days;
♦ econazole - vaginal cream, 0.15 g, 3 days;
♦ batrafen - vaginal cream 5 g at night, 10 days. Triazole preparations:
♦ fluconazole - 0.05 -0.15 g 1 time / day, 7-14 days;
♦ itraconazole (orungal) - 200 mg 1 time / day, 7 days. N-methylnaphthalene derivatives:
♦ lamisil - 0.25 g 1 time / day. (regardless of food intake), 2-4 weeks.

Antifungal antibiotics:
♦ nystatin - 500 thousand units 4-5 times / day, 10-14 days. To increase the effect, oral administration of nystatin is combined with intravaginal suppositories of 100 thousand units for 7-14 days;
♦ levorin - 500 thousand units 2-4 times / day, 10-12 days;
♦ amphoglucamine - 200 thousand units 2 times / day, 10-14 days.

Topical preparations:
♦ imidazoya derivatives (clotrimazole, miconazole, bifonazole, ginezol, ginalgin, isoconazole) - 1 vaginal suppository or 1 portion of vaginal cream at night for 10 days;
♦ dekamin - 1% ointment vaginally 1-2 times / day, 2-3 weeks;
♦ polygynax complex (neomycin, polymyxin, nystatin) at night, 1 suppository for 12 days;
♦ macmiror complex (nifuratel, nystatin) - vaginal suppositories for the night;
♦ terzhinan (neomycin, nystatin, ternidazole) - 1 vaginal suppository at night, 10 days;
♦ pimafucort (amycin, neomycin, hydrocortisone). It is used as a cream or ointment 2-4 times / day, 14 days;
♦ meratin combi (ornidazole, neomycin, nystatin) 1 vaginal suppository at night, 10 days;
♦ betadine - 1 vaginal suppository (0.2 g), 14 days.

CONTROL OF THE TREATMENT OF VULVOVAGINAL CANDIDIOSIS

• In the acute form, control of treatment is carried out 7 days after the end of treatment.
• In chronic VVC, the evaluation of the effectiveness of treatment is performed within 3 menstrual cycles on the 1st day after the end of menstruation.

Microscopy of smears of vaginal discharge is performed (native and Gram-stained preparations). Sowing of the discharge is necessary when the pathogen is not detected by microscopy, as well as in chronic recurrent VVC (in the latter case, the specific identification of the pathogen and the determination of sensitivity to antifungal drugs are required).

Vulvovaginal candidiasis is caused by fungi belonging to the Candida family. This disease is quite common and can cause a lot of problems for the fairer sex, and with a neglected form and improper treatment, it can even lead to sad consequences.

That is why the information in this article is very useful for women, as in it we will talk about the prevention of the disease, its main symptoms and the most effective methods of treatment.

For further reproduction of the fungus, special conditions are necessary. This is supported by:

• Wearing underwear made from poor quality synthetic materials. It contributes to increased sweating in the genital area and the creation of the most comfortable conditions for the appearance and reproduction of infection;
• Chronic or acquired diseases (for example, tuberculosis, diabetes mellitus, etc.);
• Use of hormonal oral contraceptives;
• Excessive consumption of alcoholic beverages and tobacco products;
• The use of intimate hygiene products, which include a large number of flavors and other harmful substances.

At-risk groups

Recently, vulvovaginal candidiasis has become one of the most common female diseases. It can affect almost every girl, but if she belongs to the so-called risk group, then the possibility of infection increases several times. This category includes women whose immunity has been weakened for various reasons.

This factor helps to reduce the number of beneficial bacteria that prevent the development of the virus in the female genital organs. In the future, this circumstance leads to a decrease in the incubation period of the infection and the rapid infection of quite large areas of the body with it.

Factors contributing to a decrease in immunity and infection with candidiasis:

• Violation of the general hormonal background of the body associated with the use of potent drugs
• Regular use of antibiotics
• Pregnancy
• Recent major surgery or mechanical injury
• Serious diseases of the endocrine system or internal organs
• Non-compliance with the rules of personal hygiene

Main signs and symptoms

Despite the fact that in general the symptoms of all diseases caused by fungi of the Candida family are similar to each other, the signs of vulvovaginal candidiasis still have a number of differences.

This fungal infection is characterized by the following manifestations:

1. Abundant cheesy vaginal discharge, which is most often off-white or gray in color;
2. Itching, sometimes turning into an unbearable burning sensation in the genital area. Its increase is often recorded during brisk walking, sexual intercourse with one's partner, and during menstruation;
3. Unpleasant pain during urination.

Also, vulvovaginal candidiasis is unmistakably indicated by the appearance of a characteristic white coating on the vaginal mucosa or on the skin of the genital organs. It is quite difficult to separate even with the help of special medical equipment.

The surface affected by it in most cases acquires a bright red color, a large number of microcracks and small ulcers form on it.

The genitals with vulvovaginal candidiasis swell. In some cases, the affected areas may bleed profusely enough.

The disease is especially dangerous for pregnant women. When the first signs of infection appear, treatment should be started immediately, since in the future this ailment can cause:

• Small weight newborns;
• Vaginal stenosis;
• Premature births and even miscarriages.

Features of treatment

Treatment of the disease, as mentioned above, should be started immediately after its diagnosis. This is due to the fact that after two to three months, vulvovaginal candidiasis becomes chronic, and it becomes much more difficult to successfully deal with it.

In the early stages of the development of the disease, you can get rid of it with the help of centuries-old folk methods. Our grandmothers used for treatment such means as:

• Soda solution, creating conditions unsuitable for the further development of the fungus;
• Chamomile and calendula decoctions, which have excellent antifungal properties;
• An infusion of oak bark that boasts excellent antiviral and anti-inflammatory properties.

When using such funds for complete healing, it will take from several days to a couple of weeks. However, in the event of the transition of the disease to a neglected form, it will not be possible to do without the use of medications.

For this reason, in acute vulvovaginal candidiasis, experienced gynecologists recommend the use of local antifungal therapy, thanks to which it is possible to localize the infected area and effectively act on pathogenic microorganisms.

Most often, special creams, ointments and vaginal suppositories are used to treat the vaginal mucosa or skin. The effectiveness of this method of treatment is significantly increased if it is combined with the simultaneous administration of drugs that can relieve itching and immunostimulating substances.

If all the symptoms indicate a chronic form of the disease, then the systemic method of treatment will be the most effective - local therapy will simply be powerless, since the fungus stops developing on the mucous membrane and begins to affect the internal organs.

Preparations

In the treatment of this form of thrush, strong antifungal drugs such as fluconazole or itraconazole should be preferred. It will also not be superfluous to take special antibiotics - livorin and nystatin.

The success of the course is evaluated only in the laboratory. In the acute form of the disease, the patient will need to pass all the necessary tests once, but in the chronic form, the examination must be carried out at least three times during the quarter.

After the elimination of the source of infection, you should proceed to the next stage of treatment, which minimizes the risk of re-infection. To do this, the surface of the mucosa is treated with special preparations developed on the basis of natural lactobacilli. They help to normalize the microflora of the genital organs, restore acceptable acid balance, etc.

And finally, one cannot fail to mention the following point - the treatment of vulvovaginal candidiasis at the chronic stage at home is not permissible. Not only will this not help to eliminate the source of the disease, but, on the contrary, it will lead to extremely undesirable consequences, in particular, to the further development of the fungus and infection of other organs.

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