Yeast vaginitis (candidiasis) is an infection or inflammation of the vagina caused by a fungus, usually the yeast-like fungus Candida albicans (C. albicans). It is the second most common type of vaginal infection. It is estimated that approximately 75% of all women in the United States will have a yeast infection at least once in their lifetime. Therefore, it is important for women to be aware of this condition.
It is believed that the Candida may live in small amounts in the healthy vagina. The predominant organism of the vagina is lactobacillus. The presence of lac-tobacillus helps in the maintenance of the normal vaginal pH of 4.5 or less. Any condition that alters or disturbs the vaginal flora, or this normal pH balance, can promote multiplication of other organisms including C. albicans, resulting in infection. Conditions that increase the risk for yeast infection are pregnancy, obesity, diabetes mellitus, the use of some drugs such as corticosteroids, broad-spectrum antibiotics, oral contraceptives, or high-carbohydrate diets. In addition, douching, hot weather along with the use of tight-fitting clothes, or nonabsorbent underwear can contribute as well. Women who are immunocompromised (such as patients with HIV or those receiving chemotherapy) are also at increased risk for yeast infection.
The severity of symptoms varies among women, but patients with vulvovaginal candidiasis usually present with a white, curd-like, cheesy vaginal discharge which adheres to the vaginal wall, intense vulvovaginal pruritus and erythema (swollen, red, itchy, tender labia), a burning sensation following urination, and pain during sexual intercourse (dyspareunia). For most women, the major system is vaginal itching. The discharge of a yeast infection is not malodorous. Diagnosis is usually made by presenting symptoms, physical examination, and by the presence of pseudohyphae with yeast buds on wet mount using potassium hydroxide (KOH).
Treatment may be prescribed as topical or oral antifungals. Topical antifungals are usually in the form of vaginal tablets, creams, or suppositories. An oral anti-fungal commonly used is fluconazole (Diflucan), which may be given in a single dose. Topical agents include butoconazole (Femstat), clotrimazole (Gyne-Lotrimin), miconazole (Monistat), tiaconazole (Vagistat), and ter-conazole (Terazol). Clotrimazole and miconazole (Monistat) are over-the-counter agents. Topical antifun-gal treatment may be used as 1-, 3-, 5-, 7-, or 14-day regimens. Women with recurrent yeast infection, defined as more than four episodes in 1 year, may be put on suppressive therapy with oral ketoconazole 100 mg daily for up to 6 months.
Preventive measures include keeping the genital area clean; avoiding the use of douches, vaginal deodorants, and tight-fitting and nonabsorbent undergarments. Nylon underwear should be replaced by cotton alternatives. Under circumstances where antibiotic use is necessary, the health care provider may offer concurrent antifungal prophylaxis. Discontinuing oral contraceptives or other hormones may be necessary in some patients to control the recurrence of infection. The health care provider may recommend good diabetic control and weight loss in the very overweight patient. Dietary modification, such as the use of acidophilus-based products and limited simple sugars and carbohydrates, may also be recommended.
- DeCherney, A. H., & Lauren, N. (2003). Current obstetrics and gynecologic diagnosis and treatment. Benign disorders of the vulva and vagina (9th ed., pp. 652—653). New York: McGraw-Hill.
- Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (2003). Current medical diagnosis and treatment. Gynecology (42nd ed., p. 703). New York: McGraw-Hill.
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