Vulvovaginal Candidiasis Flashcards by Mollie O

What is vulvovaginal candidiasis?

A fungal infection of the lower female reproductive tract

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What is vulvovaginal candidiasis more commonly known as?

Thrush

- Yeast infection

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When does the prevalence of vulvovaginal candidiasis peak?

20-40 years old

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What proportion of the female population will experience vulvovaginal candidiasis at least once?

Most

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What is the causative organism in 90% of vulvovaginal candidiasis cases?

Candida albicans

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Where is candida albicans found?

As part of the body’s normal flora in the GI tract

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How does candida albicans replicate?

Budding

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What can occur as a result of candida albican existing as part of the normal GI flora?

Oral candidiasis can occur in men and women

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What is candidiasis traditionally thought of as?

Opportunistic infection

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What is an opportunistic infection?

One that exploits opportunities of weakened host e.g. compromised immune system or altered microbiota

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What is no thought to contribute to vulvovaginal candidiasis?

Hypersensitivity reaction to candida albicans
Genetics
Oestrogen levels

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What % of women may carry candida albicans asymptomatically?

20%

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What are the risk factors for vulvovaginal candidiasis?

Pregnancy
Diabetes
Use of broad spectrum antibiotics
Use of corticosteroids
Immunosuppression or immunocompromisation

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Why can broad spectrum abx lead to vulvovaginal candidiasis?

They can alter the normal vaginal flora allowing candida albicans to overgrow

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How can corticosteroids use lead to vulvovaginal candidiasis?

It has an immunosuppressive action

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Who can be at risk of vulvovaginal candidiasis due to immune system reduction?

HIV patiens

- Cancer patients

What can occur to patients who are immunosuppressed/compromised who have vulvovaginal candidiasis?

Can lead to life-threatening infection

What are the symptoms of vulvovaginal candidiasis?

Pruritus vulvae
Vaginal discharge
Dysuria

What are the examination findings in vulvovaginal candidiasis?

Erythema and swelling of the vulva
Satellite lesions
Curd-like discharge in vagina

What are the satellite lesions seen in vulvovaginal candidiasis?

Red pustular lesions with superficial white/creamy pseudomembranous plaques that can be scraped off

What are the differentials for vulvovaginal candidiasis?

BV
Trichomoniasis
STI
Atrophic vaginitis
Lichen sclerosis
Contact dermatitis
Eczema
Psoriasis
Recto-vesical fistula
UTI

What is an important underlying disorder to rule out when presented with vulvovaginal candidiasis?

What investigations are needed to diagnose vulvovaginal candidiasis?

None if the history indicates an acute uncomplicated case

What investigation can be undertaken if examining a woman for vulvovaginal candidiasis?

What is defined as an acute uncomplicated case of vulvovaginal candidiasis?

- Sporadic - Mild to moderate symptoms - No risk factors

What tests should be carried out in complicated cases of vulvovaginal candidiasis?

- Vaginal smear | - Microscopic investigation

What features of microscopy are indicative of vulvovaginal candidiasis?

- Spores | - Mycelia

What advice should be given to people with vulvovaginal candidiasis?

- Use a soap substitute to clean - Use emollient - Wear loose fitting clothes - Good hygeine

What should be prescribe for a single episode of vulvovaginal candidiasis?

Intravaginal antifungal e.g. clotrimazole or oral antifungal e.g. fluconazole

Where can antifungals for vulvovaginal candidiasis be obtained?

OTC

What is important to keep in mind when using topical treatments for vulvovaginal candidiasis?

They can weaken latex condoms

After what period of no response to treatment should women return?

7-14 days

What should be considered if vulvovaginal candidiasis does not respond to treatment?

- Alternative diagnosis - Predisposing risk factors - Patient's concordance with medication

What should be performed if considering alternative diagnosis for vulvovaginal candidiasis?

- Vaginal pH | - Vaginal swab for microscopy and culture

When should vulvovaginal candidiasis be referred to a specialist?

- If non-albicans Candida species | - No symptom resolution

How should severe cases of vulvovaginal candidiasis be treated?

3 doses of oral fluconazole 3 days apart

How are oestrogen levels thought to increase risk of vulvovaginal candidiasis?

- By stimulating increased glycogen production providing a more favourable environment for candida growth - Directly promoting growth and adherence of candida

What is the result of oestrogen promoting candida growth?

Increased risk of vulvovaginal candidiasis in pregnancy

How should vulvovaginal candidiasis be managed in pregnancy?

- Treat with intravaginal antifungal - Don't give oral antifungals - Treat vulval symptoms with topical antifungals - Be careful when inserting intravaginal applicator - Ensure history is not suspicious for STI - Advise to return if not resolved in 7-14 days