Vulvovaginal Candidiasis (Genital Thrush): Causes, Symptoms, Treatment, and Complications
Introduction
Vulvovaginal candidiasis (VVC), commonly known as genital thrush or vaginal yeast infection, is a common fungal infection caused by a buildup of Candida albicans or other Candida species in the vaginal and vulvar areas. This condition can result in itching, discomfort, and thick discharge. If left untreated or recurring, it might cause difficulties. Understanding the causes, symptoms, treatments, and prevention measures is critical for vaginal health.
Common Symptoms of Vulvovaginal Candidiasis
Anatomy of the Female Reproductive System
Women with vulvovaginal candidiasis may encounter:
- Itching and irritation of the vagina and vulval areas.
- The discharge is white, odorless, and typically resembles cottage cheese.
- Soreness or burning during urination or sexual activity.
- Redness and swelling in the vaginal region.
These symptoms can range from mild to severe, frequently disturbing everyday activities and causing significant discomfort.
Complications of Vulvovaginal Candidiasis
Recurrent vulvovaginal candidiasis (RVVC) can lead to the following consequences if left untreated:
- Symptoms that reoccur in between antifungal treatments indicate a poor or partial response.
- Psychosexual problems and emotional anguish brought on by discomfort during sexual activity are among the effects on quality of life.
persistent symptoms that could affect sexual health and day-to-day activities
When to See a Doctor
The majority of yeast infections are treatable with over-the-counter drugs, however, it’s crucial to consult a doctor if:
- Immunocompromised people, such as those living with HIV.
- The infection either becomes chronic or recurs often.
- Women with diabetes, particularly if:
- There are issues with managing their diabetes or symptoms of uncontrolled blood sugar (such as Fatigue, thirst, or frequent urination).
- They frequently get yeast infections and have diabetes, which they don’t know how to control.
- After seven days of treatment, the symptoms still exist.
- The accompanying symptoms include fever, stomach ache, or an unpleasant-smelling discharge.
- The diagnosis or suspicion of an underlying sexually transmitted infection (STI) is not entirely clear.
Diagnosis and Treatment of Vulvovaginal Candidiasis
Candida Albicans Structure
Candida Albicans Under Microscope
Diagnosis
A healthcare provider diagnoses vulvovaginal candidiasis based on symptoms, a pelvic exam, and, if necessary, a vaginal swab to identify the specific Candida strain.
Treatment Options for Genital Thrush Vulvovaginal Candidiasis
NEW Drug Approval -2021 — BREXAFEMME (Ibrexafungerp) Summary:
- Purpose: BREXAFEMME is an oral antifungal drug used to treat vaginal yeast infections (vulvovaginal candidiasis) in females who have started menstruation.
- MOA of BREXAFEMME (Ibrexafungerp): Unlike traditional antifungals that target fungal cell membranes, ibrexafungerp inhibits an enzyme essential for fungal cell wall formation, making it effective against a variety of Candida species, including strains resistant to common antifungals like fluconazole
- Dosage: Two tablets taken 12 hours apart in one day, totaling 600 mg.
BREXAFEMME
- Clinical Trials: Approved by the FDA based on trials with 820 participants from the U.S. and Bulgaria. Trials showed a greater resolution of infection symptoms in BREXAFEMME users compared to placebo.
- Side Effects: Common side effects include diarrhea, nausea, abdominal pain, dizziness, and vomiting. BREXAFEMME is not recommended during pregnancy due to potential birth defects.
- Demographics: Most trial participants were under 65, with 69% White and 28% Black or African American participants.
1st Line Treatment:
- Fluconazole 150 mg oral dose is the standard treatment for most acute yeast infections.
Fluconazole 150mg Capsule
- Mechanism of Action (MOA) of Fluconazole: causes cell death by preventing the production of ergosterol, an essential part of fungal cell membranes, by inhibiting the enzyme lanosterol 14α-demethylase.
2nd Line Treatment (If Oral Therapy is Contraindicated):
- Clotrimazole 500 mg intravaginal pessary as a single dose is recommended for women unable to take oral antifungal medication.
Clotrimazole 500 mg intravaginal pessary
- Mechanism of Action (MOA) of Imidazoles and triazoles: are preferable for systemic infections because of their superior efficacy, longer half-lives, and less adverse effects. Both imidazoles and triazoles are broad-spectrum antifungals that disrupt ergosterol synthesis by inhibiting the enzyme lanosterol 14α-demethylase.
3rd Line Treatment (If Oral and 2nd Line Treatments Are Not Tolerated):
- 10% intravaginal clotrimazole cream applied at night can be an alternative, especially for those unable to tolerate other treatments.
10% intravaginal clotrimazole cream
For Vulval Symptoms:
- If there are vulval symptoms (e.g., external itching or irritation), a topical clotrimazole cream (1%) may be added alongside the primary treatment.
Clotrimazole cream (1%)
Treatment Failure
- Imidazole antifungals, such as clotrimazole, cause treatment failure in about 20% of women. Other antifungal treatments and more testing could be required in these situations.
Vulvovaginal Candidiasis Preventive measures
Take into account the following lifestyle changes to avoid yeast infections:
1. Dress in breathable clothing
Clothing that is too tight, particularly made of synthetic materials, might retain moisture and foster the growth of yeast. Wearing loose-fitting clothing and cotton underwear improves airflow and reduces the risk of infection.
2. Steer clear of scented toiletries
The normal pH balance in the vagina can be disrupted by scented soaps, sprays, and pads, which raises the risk of infection. Always go for hypoallergenic, odorless products.
3. Control Blood Sugar Levels
Controlling blood sugar levels is essential for diabetic women. Effective diabetes control can lower the risk of recurring infections since high glucose levels promote the growth of yeast.
4. Proper Hygiene Procedures
Wash the genital area with warm water to maintain proper hygiene. Always wipe from front to back after using the restroom to stop bacteria from spreading from the rectum to the vagina.
For more on preventing yeast infections, refer to the Mayo Clinic’s Yeast Infection Prevention Guide.
FAQs About Vulvovaginal Candidiasis
1. Why does vulvovaginal candidiasis recur?
A compromised immune system, regular antibiotic usage, or uncontrolled diabetes can all contribute to recurrent yeast infections.
2. What is the duration of treatment for a yeast infection?
With the right care, most infections go away in 3–7 days, but recurring infections can take longer or call for more potent treatments.
3. Is it possible to spread vulvovaginal candidiasis?
Yeast infections are not considered STIs, however, they can sometimes be transferred from one sexual partner to another.
4. Can yeast infections affect men?
Males can indeed have balanitis, a yeast infection that affects the penis’s head and foreskin.
5. Can pregnancy be impacted by vulvovaginal candidiasis?
Pregnancy-related yeast infections are prevalent and should be treated right once to prevent problems.
1. What causes recurring vulvovaginal candidiasis?
Recurring yeast infections may be due to uncontrolled diabetes, frequent antibiotic use, or a weakened immune system.
2. How long does it take to treat a yeast infection?
Most infections resolve within 3 to 7 days with the appropriate treatment, though recurrent cases may take longer or require stronger therapies.
3. Is vulvovaginal candidiasis contagious?
While not classified as an STI, yeast infections can occasionally be passed between sexual partners.
4. Can men get yeast infections?
Yes, men can develop balanitis, a yeast infection affecting the foreskin and head of the penis.
5. Can vulvovaginal candidiasis affect pregnancy?
Yeast infections are common during pregnancy and should be treated promptly to avoid complications.
Conclusion
When treated quickly, vulvovaginal candidiasis is a common and treatable illness. Most women can avoid recurrence with the right care and precautions. For more sophisticated treatment choices, it’s crucial to consult a doctor if symptoms worsen or infections start to recur.
References
- Centers for Disease Control and Prevention (CDC). (2024) Vaginal Candidiasis – Fungal Diseases. Available at: https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html (Accessed: 19 October 2024).
- British Association for Sexual Health and HIV (BASHH). (2024) Vulvovaginal Candidiasis Guidelines. Available at: https://www.bashhguidelines.org/ (Accessed: 19 October 2024).
- World Health Organization (WHO). (2024) Sexually Transmitted Infections (STI) Management Guidelines. Available at: https://www.who.int (Accessed: 19 October 2024).
- Royal College of Obstetricians and Gynaecologists (RCOG). (2024) Vaginal Infections Guidelines. Available at: https://www.rcog.org.uk/ (Accessed: 19 October 2024).
- Infectious Diseases Society of America (IDSA). (2024) Guidelines on Candida Infections. Available at: https://www.idsociety.org/ (Accessed: 19 October 2024).
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID). (2024) Guidelines on Candida Infections. Available at: https://www.escmid.org (Accessed: 19 October 2024).
- Sobel, J. D. (2021) ‘Recurrent Vulvovaginal Candidiasis: Overview and Management Approaches’, Clinical Infectious Diseases, 52(Suppl 6), pp. S443–S447. Available at: https://doi.org/10.1093/cid/cir081 (Accessed: 19 October 2024).
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