Vulvovaginal Candidiasis Flashcards
What is vulvovaginal candidiasis?
A fungal infection of the lower female reproductive tract
What is vulvovaginal candidiasis more commonly known as?
- Thrush
- Yeast infection
When does the prevalence of vulvovaginal candidiasis peak?
20-40 years old
What proportion of the female population will experience vulvovaginal candidiasis at least once?
Most
What is the causative organism in 90% of vulvovaginal candidiasis cases?
Candida albicans
Where is candida albicans found?
As part of the body’s normal flora in the GI tract
How does candida albicans replicate?
Budding
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
What is candidiasis traditionally thought of as?
Opportunistic infection
What is an opportunistic infection?
One that exploits opportunities of weakened host e.g. compromised immune system or altered microbiota
What is no thought to contribute to vulvovaginal candidiasis?
- Hypersensitivity reaction to candida albicans
- Genetics
- Oestrogen levels
What % of women may carry candida albicans asymptomatically?
20%
What are the risk factors for vulvovaginal candidiasis?
- Pregnancy
- Diabetes
- Use of broad spectrum antibiotics
- Use of corticosteroids
- Immunosuppression or immunocompromisation
Why can broad spectrum abx lead to vulvovaginal candidiasis?
They can alter the normal vaginal flora allowing candida albicans to overgrow
How can corticosteroids use lead to vulvovaginal candidiasis?
It has an immunosuppressive action
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?
DM
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?
pH
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
