Symptoms
Acute, uncomplicated vaginal mycosis occurs more frequently in women of childbearing age. In contrast, it is rare in girls and postmenopausal women. About 75% of all women contract vaginal mycosis once in their lives. The clinical manifestation varies. Possible symptoms include:
- Itching and burning (leading symptoms).
- Inflammation of the vagina and vulva with symptoms such as burning, redness, swelling and pain, whitish coating.
- No to light to heavy, thin, watery to lumpy discharge.
- Only faint odor
- Pain during sexual intercourse
- Burning during urination
In severe forms, there may be erosions of the vagina and skin lesions in the vaginal area and thighs. Other possible complications include chronic recurrent vaginal mycosis and loss of quality of life.
Causes and transmission
It is an infection with yeast, in over 85% to 95% of cases with , rarely with or other -species. Vaginal candidiasis is one of the opportunistic infections. The fungi may occur naturally in the vagina in many women; only favored by a number of factors results in infection. Risk factors include:
- Pregnancy
- Treatment with antibiotics
- Sexual intercourse, especially orogenital sexual practices.
- Possibly hormonal contraceptives.
- Suppression of the immune system by a disease (HIV) or drugs, for example glucocorticoids.
- Uncontrolled diabetes mellitus
- Heredity
- Tendency to allergic diseases
Numerous other factors are discussed, but are controversial. The fungi can possibly come from the rectum, from the vagina (recurrence) or from the penis of the partner. It is known that men can also be asymptomatically infected, but what role this actually plays in transmission is uncertain.
Diagnosis
Diagnosis is made by medical treatment on the basis of patient history, clinical inspection, microscopy from vaginal secretions, and, in some circumstances, by growing a fungal culture. Microscopy is often negative despite active infection.
Differential diagnoses
It is not possible to make the diagnosis based on symptoms alone, and a 1990s study showed that . It is likely that other causes of vaginitis are under-recognized. Empirical self-treatment is possible, but accurate clarification requires a gynecological examination. Bacteria (e.g., gonorrhea, genital chlamydial infection), viruses (e.g., genital herpes), and parasites (e.g., trichomoniasis) may also be causative agents of vaginitis. Other differential diagnoses include cystitis and skin conditions such as atrophic, allergic, or irritant vaginitis, trauma, foreign bodies, warts, scabies, and crabs.
Drug treatment
The main drugs used to treat acute and uncomplicated infection are antifungals (antifungals), which are administered either locally or orally. Both treatment options are about equally effective and have advantages and disadvantages (Nurbhai et al, 2007). Co-treatment of the partner is only necessary if the partner also shows symptoms. These include itching, burning, redness and white coating on the penis (balanitis mycotica). For the treatment of special patient groups (e.g. pregnant women, diabetes, immunosuppression, chronic disease), please refer to the literature. For symptomatic treatment, glucocorticoids are used against the skin lesions, washing lotions and skin care products, among others. Local antifungal agents:
- Topical antifungal agents are applied locally vulvovaginally. Crèmes are used for external treatment; a vaginal tablet, ovulum, or vaginal cream are administered internally in the vagina. Clotrimazole (eg, Gyno-Canesten, Fungotox) is one of the most commonly used in practice because it is available without a doctor’s prescription from the age of 18.
- In addition, there are numerous alternatives on medical prescription: butoconazole (Gynazole), econazole (Gyno-Pevaryl), miconazole (Monistat), ciclopirox (Dafnegil), nystatin. The duration of therapy differs depending on the active ingredient and dosage form and can be 1, 3, to 15 days.According to the literature, the differences in efficacy are marginal. Local application carries a lower risk of adverse effects. Hypersensitivity reactions and local irritation may occur.
Systemic antifungals:
- For internal treatment, tablets or capsules are taken. Active ingredients used include fluconazole (Diflucan, generic) and itraconazole (Sporanox G, generic). This method of treatment is less inconvenient, but more adverse effects and interactions with other medications are possible when taken. It is usually taken either as a single dose (fluconazole, 1 x 1) or on two consecutive days (itraconazole, 2 x 2). Other antifungal drugs are also approved in different therapeutic regimens, for example, ketoconazole (Nizoral, intake during 5 days).
Antiseptics:
- In addition to antifungals, some antiseptics are also used alternatively for local treatment in the form of vaginal ovules or tablets. These include dequalinium chloride (Fluomizin), povidone–iodine (Betadine Ovula), octenidine and hexetidine (Vagi-Hex).
Alternative medicine:
- In alternative medicine, for example, garlic cloves (wrapped in gauze and crushed), tea tree oil (a few drops in a bath or vaginal gel or in St. John’s oil) are used. Possible side effects include local irritation. We do not know the effectiveness of these methods.
Prevention
For prevention, there are a number of behavioral recommendations, but from our point of view, the evidence is limited. Systemic antifungals such as fluconazole are also taken as a preventive measure. Probiotics such as Lactobacillus are placed in the vagina in the form of yogurt on tampons or ovules (e.g., Gynoflor) as a preventive measure to restore the natural vaginal flora.
During pregnancy
The literature recommends seeing your health care provider if you have vaginal thrush during pregnancy.
