Vulvovaginal candidosis

Last Updated: 2020-07-21

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Candidavulvovaginitis, vaginal mycosis, vulvovaginitis candidamycetica, candidacolpitis, candidosis of the vulva, vaginal thrush, thrush colpitis.

Candida infection of the vulva and vagina.

 

Lifetime prevalence: 75% of all women

  • Predisposing factors:
    • Gravity
    • Already experienced STI
    • Adnexitis
    • Urethra inflammation
    • Extrauterine pregnancy
    • Sterility problems
    • ↑ sexual activity with different partners (especially without using a condom)
    • Irritation (vaginal irrigation)
    • Diabetes mellitus
    • Oral contraceptive use
    • Glucocorticoid therapy
    • Antimycotic therapy
    • Frequent eating of sweet food 
    • Fecal Candidosis

Transmission can be via the GI tract, as well as via sexual intercourse (partners with Candida infection or sperm colonized with Candida). Transmission is also possible through asymptomatic partners.

Erythematous, pruriginous-burning, partly flat confluent papules in the area of the vulva, like whitish discharge, partly whitish coatings are visible. Colpitis up to necrotizing colpitis.

  • Clinical features
  • Native preparation: The slide is smeared with vaginal secretion. After 1 curd NaCl solution has been applied, the pathogen can be found under the microscope
  • Pathogen detection: Myco. smear (native and culture)
  • Germ tube test
  • Hygiene:
    • Washcloths should not be used because of the risk of contamination
    • Underwear and towels should be changed daily and washed at >60°C
    • Do not use tampons!
  • Ev. application of Lactobacillus acidophilus
  • Frequent relapses
  • Stool cultures during the course are important!
  • Can only be trated well with topical therapy
  • Partner treatment (also for asymptomatic partners)!
  • If there is an underlying predisposing disease, it should be addressed therapeutically
  • Vaginal tablets

    • Clotrimazole 1 tbl. on 3 consecutive days
    • Econazole 2 tbl. at 12 hour intervals
    • Ciclopirox 1 tbl. on 3 consecutive days.
  • Topical therapy

    • Clotrimazole cream
    • Econazole cream (1 %)
    • Ciclopirox cream
  • Systemic therapy

    • In recurrent candidiasis:
      • Itraconazole p.o. 200 mg 1x a day once
      • Alternative: Fluconazole p.o. 150 mg once only
      • Alternative: Terbinafine p.o. 250 mg 1x a day

 

  • For resistant C. glabrata or C. krusei infections:
    • Voriconazole p. o. Initial dose: 200 mg 2x daily for 3 days
    • Posaconazole p.o. 400 mg 2x daily for 10 days

 

  • If necessary, simultaneous treatment of the intestinal mycosis!
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  2. Williams D, Lewis M. Pathogenesis and treatment of oral candidosis. J Oral Microbiol 2011;3.
  3. Scully C, el-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med 1994;5:125-57.