Candida vulvovaginitis: Difference between revisions
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==Background== | ==Background== | ||
*Local fungal infection caused by the [[Candida]] genus | *Local fungal infection caused by the [[Candida]] genus | ||
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity, diabetes mellitus | *Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity, diabetes mellitus | ||
*Not considered an STI although it can be transmitted by sexual intercourse | *Not considered an STI although it can be transmitted by sexual intercourse | ||
*May occur in premarnarcheal girls (rare) | *May occur in premarnarcheal girls (rare) | ||
*Can occur as a result of antibiotic use | |||
===Types=== | ===Types=== | ||
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==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>== | ==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>== | ||
[[File:Candida vaginitis.JPG|thumb|Candida vaginitis]] | [[File:Candida vaginitis.JPG|thumb|Candida vaginitis]] | ||
*Vulvar pruritus - most common and specific symptom | *Vulvar [[pruritus]] - most common and specific symptom | ||
*Vaginal discharge - varies from little to copious and from watery to cottage-cheese like | *[[Vaginal discharge]] - varies from little to copious and from watery to cottage-cheese like | ||
*Malodorous smell is unusual (if present favors diagnosis of [[Bacterial vaginosis]]) | *Malodorous smell is unusual (if present favors diagnosis of [[Bacterial vaginosis]]) | ||
* intense vulvovaginal | *intense vulvovaginal [[pruritus]] or burning | ||
* dyspareunia | *dyspareunia | ||
* dysuria | *[[dysuria]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Vaginal wet mount of candidal vulvovaginitis.jpg|thumb|KOH test on a vaginal wet mount, showing slings of pseudohyphae of Candida albicans surrounded by round vaginal epithelial cells.]] | |||
===Work-up=== | ===Work-up=== | ||
*Wet mount - shows hyphae and yeast buds | *Wet mount - shows hyphae and yeast buds | ||
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===Diagnosis=== | ===Diagnosis=== | ||
* although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis | *although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis | ||
* cotton cheese curd-like non-odorous vaginal discharge on pelvic exam | *cotton cheese curd-like non-odorous vaginal discharge on pelvic exam | ||
* vaginal pH < 4.5 | *vaginal pH < 4.5 | ||
* vaginal wet mount | *vaginal wet mount | ||
==Management== | ==Management== | ||
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*Sexual partners should not be treated unless the patient has frequent recurrences | *Sexual partners should not be treated unless the patient has frequent recurrences | ||
*Antifungal<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref> | *Antifungal<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref> | ||
**1st line: Oral Fluconazole | **1st line: Oral [[Fluconazole]] | ||
**Pregnant: Topical imidazole (clotrimazole, miconazole) | **Pregnant: Topical imidazole ([[clotrimazole]], [[miconazole]]) | ||
===Antifungals=== | ===Antifungals=== | ||
Revision as of 23:09, 29 April 2020
Background
- Local fungal infection caused by the Candida genus
- Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity, diabetes mellitus
- Not considered an STI although it can be transmitted by sexual intercourse
- May occur in premarnarcheal girls (rare)
- Can occur as a result of antibiotic use
Types
- Uncomplicated
- Sporadic infectionn
- mild-moderate symptoms
- due to Candida albicans
- immunocompetent
- Complicated
Clinical Features[1]
- Vulvar pruritus - most common and specific symptom
- Vaginal discharge - varies from little to copious and from watery to cottage-cheese like
- Malodorous smell is unusual (if present favors diagnosis of Bacterial vaginosis)
- intense vulvovaginal pruritus or burning
- dyspareunia
- dysuria
Differential Diagnosis
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Atrophic vaginitis
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Vaginal foreign body
Evaluation
Work-up
- Wet mount - shows hyphae and yeast buds
- Candida does not cause WBCs on wet mount → if present, consider co-infection with other vaginitides or STI
- If recurrent, consider checking blood glucose for occult DM
Diagnosis
- although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis
- cotton cheese curd-like non-odorous vaginal discharge on pelvic exam
- vaginal pH < 4.5
- vaginal wet mount
Management
- Do not treat if asymptomatic
- Sexual partners should not be treated unless the patient has frequent recurrences
- Antifungal[2]
- 1st line: Oral Fluconazole
- Pregnant: Topical imidazole (clotrimazole, miconazole)
Antifungals
Intravaginal Therapy
- Clotrimazole 1 % cream applied vaginally for 7 days OR
- Clotrimazole 2% applied vaginally for 3 days
- Miconazole 2% cream applied vaginally for 7 days OR 4% cream x 3 days
- Butoconazole 2% applied vaginally x 3 days
- Tioconazole 6.5% applied vaginally x 1
Oral Therapy
- Fluconazole 150mg PO once
- a second dose at 72hrs can be given if patient is still symptomatic
Pregnant Patients
- Intravaginal Clotrimazole or Miconazole are the only recommended treatments
- Duration is 7 days
- PO fluconazole associated with congenital malformations and spontaneous abortions[3]
Disposition
- Outpatient
See Also
References
- ↑ Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.
- ↑ Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
- ↑ Molgaard-Nielsen D et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58-67.