Fungal vulvovaginitis

Abstract

Fungal vulvovaginitis remains one of the most frequent conditions affecting the lower genital tract. Recent advances in the understanding of the pathophysiology of the condition have improved our ability to treat recurrent or persistent cases. More clinical data have become available on the optimal duration of treatment with some of the newer antifungal agents.

PIP: Actual incidence of vulvovaginitis is unknown, but apparently about 75% of women experience at least 1 episode of yeast vulvovaginitis during their reproductive years. Candida species causes almost all cases, e.g., Candida albicans causes about 90% of cases. Other species include C. glabrata and C. tropicalis. The spore form of C. albicans spreads the infection and is asymptomatic. The mycelia form induces symptoms. Neither C. glabrata nor C. tropicalis produce mycelia. The 1st step in establishing an infection is bonding to the vaginal mucosa. C. albicans adheres better than do the other 2 species. Proteolytic enzymes help the fungus bind to the mucosa. Research indicates that differences in the composition of normal vaginal bacteria, dearths in site functions that are specific for Candida, or prostaglandin or IgE interference with the cellular mediated immune response specific to Candida may be responsible for recurrent infections. The signs and symptoms of yeast vulvovaginitis are not clear cut so clinicians need to request laboratory tests on samples to confirm diagnosis. The most common symptom is considerable itching. Antifungal medicine is either topical or systemic. The most common yet oldest antifungal agent is 0.5-1% gentian violet applied topically to the affected mucous membranes. There is dome evidence, however, that it causes chromosome damage in some mammal cells. No reported cases of cancer in humans exist though. Imidazoles and polyene compounds constitute the mainstays of candidiasis treatment. Oral ketoconazole has shown promise in preventing recurrence. Colonization and symptomatic vaginitis rates rise during pregnancy. Symptomatic vaginitis is most common during the 3rd trimester. Diabetes mellitus also predisposes women to vaginitis. Women who use high dose oral contraceptives, the contraceptive sponge, and antibiotics also face increased risk of colonization and symptomatic vaginitis. Vaginitis is common among women with AIDS.