A 35-year-old woman presents with severe vaginal and vulvar itching. She also complains of a thick white discharge. Figure 83-1 demonstrates the appearance of her vagina and vulva while Figure 83-2 shows her cervix. Figure 83-3 shows her wet prep. Treatment with a nonprescription intravaginal antifungal preparation was successful.
Candida on the vulva and introitus showing whitish patches with erythema. (Courtesy of Richard P. Usatine, MD.)
Candida vaginitis. Note the thick white adherent “cottage-cheese-like” discharge. (Courtesy of the Centers for Disease Control and Prevention and Stuart Brown, MD.)
Wet mount with KOH of Candida albicans in a woman with Candida vaginitis. Seen under high power demonstrating branching pseudohyphae and budding yeast. (Courtesy of Richard P. Usatine, MD.)
Vulvovaginal candidiasis (VVC) is a common fungal infection in women of childbearing age. Pruritus is accompanied by a thick, odorless, white vaginal discharge. VVC is not a sexually transmitted disease. On the basis of clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated.1 Uncomplicated VVC is characterized by sporadic or infrequent symptoms, mild-to-moderate symptoms, and the patient is nonimmunocompromised. Complicated VVC is characterized by recurrent (four or more episodes in 1 year) or severe VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression.1
Yeast vaginitis, yeast infection, candidiasis, moniliasis.
- VVC accounts for approximately one third of vaginitis cases.1
- Candida species are part of the lower genital tract flora in 20% to 50% of healthy asymptomatic women.2
- Seventy-five percent of all women in the United States will experience at least one episode of VVC. Of these, 40% to 45% will have two or more episodes within their lifetime.3 Approximately 10% to 20% of women will have complicated VVC that necessitates diagnostic and therapeutic considerations.
- It is a frequent iatrogenic complication of antibiotic treatment, secondary to altered vaginal flora.
- Nearly half of all women experience multiple episodes, and up to 5% experience recurrent disease.1
- Recurrent vulvovaginal candidiasis (RVVC) is defined as four or more episodes of symptomatic VVC in 1 year. It affects a small percentage of women (<5%).4 Recurrent yeast vaginitis is usually caused by relapse, and less often by reinfection. Recurrent infection may be caused by Candida recolonization of the vagina from the rectum.5
- Most vulvovaginal Candidiasis is caused by Candida albicans (Figure 83-3).1,6 Candida glabrata now causes a significant percentage of all Candida vulvovaginal infections. This organism is resistant to the nonprescription imidazole creams. It can mutate out of the activity of treatment drugs much faster than albicans species.7...