Vulvovaginal candidiasis. Vulvovaginal candidiasis and its treatment. Treatment of vulvovaginal candidiasis in young children

Vulvovaginal candidiasis is a common, often infectious disease that occurs in women of different ages. This disease is most often diagnosed in young girls and women of childbearing age. Otherwise, this disease can be called thrush, vulvovaginal mycosis, genital fungus. This pathology is very widespread, diagnosed in about 45% of women. Difficulties in treatment arise due to the fact that such a disease is prone to relapses and a chronic course. This picture is formed due to the root cause of thrush. The causative agents of the disease are yeast-like pathogenic fungi, which are constantly present in different quantities in the body. There are more than 100 different types of them, so it is important to correctly select the medicine in order to have an effect. In normal times, Candida fungi do not show aggressiveness and excessive activity, they are suppressed by beneficial microflora. But if favorable conditions are created, the colonies of the fungus begin to rapidly grow, affecting the surfaces of the mucous membranes, internal organs, and skin. A disease left untreated can quickly turn into a severe and chronic form, leading to a lot of unpleasant consequences.

Symptoms of different forms of fungal disease

candidiasis under the microscope

There are three main forms of vulvovaginal candidiasis. The mild form begins abruptly, the basic symptoms are very pronounced, but under the influence of drugs, the disease disappears quickly enough. The acute form of thrush occurs when the infection does not respond to treatment. Some additional symptoms may be added. The chronic form of the genital fungus is diagnosed in cases where the disease constantly returns (more than four times in one year), its symptoms are significantly pronounced, and the therapy does not give a full result. A similar picture is observed in approximately 5% of all patients with candidal pathology.

Typical symptoms

Foci of infection are fixed in the intimate area. The mucous membranes, vagina, vulva, organs of the genitourinary system are affected. Symptoms differ in that they are pronounced, increasing with the course of the course of the disease. In rare cases, the disease can have a so-called latent form, when external signs are not visible, and the patient is diagnosed by chance after a routine examination.

The following symptoms may accompany candidiasis of the vulva and vagina:

As a rule, signs of fungal pathology are especially noticeable before or after menstruation, as well as during pregnancy. They intensify in the evening and at night, after taking a warm shower or bath. The condition worsens after intimacy, long walking or after playing sports.

What provokes the development of a painful condition

The root cause of the occurrence of thrush are fungi that exhibit aggressive activity. A variety of external and internal factors can provoke this. Despite the fact that men do not often experience obvious manifestations of candidiasis, they can act as carriers of active fungi. After unprotected sexual contact, infection occurs, and then the woman is faced with the development of the disease in herself. You can also get infected through personal hygiene items. During pregnancy, if the pathology is not treated in any way, the condition is not corrected, there is a threat of infection of the newborn.

Common Causes

The risk of developing fungal pathology can be increased by regular and severe stress, depression, improper diet and starvation, lack of vitamins and mineral microelements in the body.

Risks and Complications

With prolonged neglect of symptoms and general condition, the risks of complications increase. In this case, there is not only the threat of transition of candidiasis into a chronic and sluggish form, which will constantly accompany a woman.

The main complications are:

Therapy Options

The treatment plan is developed individually. Treatment is based on the results of the diagnosis, which includes examination and questioning of the patient, procedures and necessary tests. When selecting drugs and methods of therapy, complaints, the presence of additional diseases and possible allergic reactions, and general health are taken into account. An important role is played by data on the female microflora and which of the subspecies of harmful yeast-like fungi is active. When a candida type disease is noted in pregnant women, only a professional doctor can decide exactly which methods of correction to apply. Because of all these nuances, self-treatment and the choice of remedies against thrush should not be carried out. Otherwise, the situation can only be aggravated without getting any positive effect.

Medicines

Vulvovaginitis is treated with antifungal drugs (for example, Nystatin), imidazole agents (Bifonazole, Fluconazole, Lamisil), various topical medications (Decamine, Betadine). Iodine preparations and combined drugs (eg, Pimafucort) may be used.

Cream Mycospor containing Bifonazole

The following medications are especially often prescribed to patients:

  • Itraconazole.
  • Butoconazole.
  • Miconazole and others.

Non-drug correction options

Along with medications, traditional medicine can also be used. It is based on the selection of the most effective gynecological fees, medicinal flowers and. It may be useful to use soda solutions.

Traditional medicine acts as a so-called maintenance therapy. With the help of decoctions and infusions, washing is carried out, compresses, lotions, gauze swabs, and douching are made. However, the use of such funds should be carried out exclusively as prescribed by a medical specialist. It is important to carefully monitor your well-being so that there is no unpleasant allergic reaction to herbs.

Herbs - an effective remedy for candidiasis

The effectiveness of treatment will depend not only on the correct selection of the necessary funds. Correction of life, treatment of concomitant diseases, accurate identification of the causes provoking outbreaks of fungal pathology are important.

  1. change the diet, removing sweet, carbohydrate foods from the menu to the maximum;
  2. refrain from taking antibiotics and other potent drugs, especially those that suppress the activity of the immune system;
  3. strengthen immunity through hardening, water procedures, sports, active supplements and vitamins;
  4. to refuse sexual intercourse during treatment, from unprotected sex at other times;
  5. avoid drinking alcohol, get rid of bad habits;
  6. minimize stress in life, improve daily routine;
  7. refuse oral contraceptives containing estrogen;
  8. change your wardrobe, give up synthetic underwear;
  9. improve daily intimate hygiene, refrain from using untested products;
  10. timely treat any diseases, inflammatory processes, maintain general well-being in the norm;
  11. avoid overheating and hypothermia, any negative effects on the immune system.

It will also be important to implement preventive measures that will prevent the recurrence of this fungal pathology. They build on the additional tips above. In addition, after consulting with your doctor, you can take preventive medications from time to time.

14.04.2017

Vulvovaginal candidiasis (VVC) is an infectious urogenital disease that affects the mucous membrane of the vagina, vulva, perineum, and urethra.

The inflammatory process is caused by Candida fungi. In terms of frequency of cases, the manifestation of VVC is in 2nd place after bacterial vaginosis.

More than half of the women on the planet have experienced signs of vulvovaginal candidiasis once in their lives. To reduce the likelihood of a disease, you need to take antibiotics only as directed by a doctor, maintain immunity, adjust your diet, choose the right contraceptives, and maintain personal hygiene.

In medicine, 2 forms of the disease are distinguished for vulvovaginal candidiasis - acute and chronic. The causative agent of the disease is more often fungi of the Candida family (C. albicans, C. krusei, C. pseudotropicalis, C. parapsilosis C. glabrata), but recently the number of diseases caused by fungi Saccharomyces cerevisae, Torulopsis glabrata, etc. has been growing.

Causes of vulvovaginal candidiasis

Normally, yeast-like fungi are present in the microflora of each person. With concomitant factors, fungi actively multiply, thrush begins.

The main reasons contributing to the increase in the activity of the fungus:

  • pregnancy, diabetes;
  • incorrectly chosen underwear (synthetics, tight);
  • long-term use of antibiotics, steroids, oral contraceptives;
  • abuse of wearing pads;
  • neglect of hygiene or excessive cleanliness.

Symptoms of VVC

A doctor should diagnose vulvovaginal candidiasis, but a woman herself can assume the presence of a disease if she notices a symptom characteristic of thrush from the following:

  • severe burning, itching of the genitals, deterioration after sexual intercourse, water procedures, during menstruation, during a long walk;
  • secretion of a curdled consistency gray-white;
  • swelling and hyperemia of the genital mucosa, bleeding wounds.

If you notice several symptoms, you need to see a doctor. If you do not start treating vulvovaginal candidiasis in time, this can lead to infections in the pelvic organs and urinary system, vaginal stenosis, premature birth, low birth weight babies, etc.

Diagnostic studies

In order to choose the right treatment, the doctor must make sure that the patient has vulvovaginal candidiasis, or identify another disease that has similar symptoms (discharge, itching, mucosal damage, etc.).

The doctor will rely on the results of the physical examination, the patient's complaints, and laboratory test data. The laboratory conducts microbiological and immunofluorescent diagnostics, serological and immunological studies. As a rule, mycosis is not sexually transmitted, but if a man is diagnosed with candidal balanoposthitis, both partners are treated.

Treatment of vulvovaginal candidiasis

Treatment of VVC in the acute form usually does not cause difficulties. The doctor prescribes suitable antifungal drugs from the azole group, for the duration of treatment, antibiotics, glucocorticoids, and hormones should be abandoned.

For successful treatment, bad habits must be eliminated, the diet adjusted, and the foci affected by the fungus should be comprehensively affected. In addition to medical preparations, recommendations are given on hygiene, the choice of underwear. Folk recipes can be used as adjuvants for the treatment of candidiasis. It can be decoctions, compresses, baths, douching with herbal solutions. The dosage and duration is determined by the doctor.

If the disease proceeds in a chronic form with regular relapses, the treatment will be difficult. The patient will be prescribed antifungal drugs, supportive therapy. The doctor chooses a local remedy based on the results of the tests, the age of the patient, concomitant diseases.

The choice of medicines will be made from the following drugs:

  • cream butoconazole 2% is injected once into the vagina in an amount of 5 mg;
  • suppositories ketoconazole 400 mg are prescribed for 3-5 days;
  • fluconazole tablets - 150 mg 1 time;
  • itraconazole 200 mg tablets are taken twice a day, the course is 3 days;
  • vaginal suppository sertaconazole 300 mg - once;
  • clotrimazole in various forms (100 mg vaginal tablets are prescribed for a week, 200 mg tablets for 3 days, a 500 mg tablet once, and a 1% cream is injected into the vagina for a week or two);
  • miconazole suppositories are prescribed 100 mg per week or 200 mg for 3 days;
  • nystatin suppositories are prescribed for 2 weeks of daily use;
  • ointment thioconazole 6.5% is applied once intravaginally.

Despite the high effectiveness of local antifungal drugs, in many patients after 3 months, vulvovaginal candidiasis reappears.

The cause of relapse may be antibiotics, which, with prolonged use, can change the microflora of the vagina. Also, the risk of getting sick with VVC is greater in those patients who use hormonal contraceptives or are carrying a child.

An increase in estrogen levels entails an increase in glycogen, which creates favorable conditions for the reproduction of fungi. For the same reason, women with diabetes often suffer from vaginal candidiasis - against its background, immunity decreases, glycogen increases.

Another factor that causes thrush to recur is an increase in the types of fungi that cause diseases. Thus, varieties of C. glabrata, C. pseudotropicalis, C. parapsilosis are less sensitive to traditional therapy than C. albicans. The complexity of the choice of the drug is due to the neglect of the recommended treatment regimen. If the patient completes the course of therapy before a complete cure has occurred, the fungi recur and become resistant to certain drugs.

It is important to consider that if local antifungal agents may be sufficient in the acute form of the disease, then chronic vulvovaginal candidiasis is treated in a complex manner - a combination of local, systemic and anti-relapse drugs. Additionally, immunomodulating agents are prescribed, as well as those aimed at normalizing the microflora.

For the treatment of the chronic form of thrush, local preparations from the azole group are prescribed for about 2 weeks. In parallel, patients are prescribed a systemic antifungal drug (itraconazole tablets twice a day, 200 mg for 3 days, fluconazole tablets 1 time a day, 150 mg for 3 days, etc.).

Prevention of candidiasis

To prevent recurrence of vulvovaginal candidiasis, your doctor may prescribe itraconazole 200 mg tablets, fluconazole 150 mg, and other drugs listed below. You will need to drink 1 tablet on the 1st day of your period. Repeat within six months. Additional assistance will be provided by local preparations, which are used once a week for the same period.

Among the popular antifungal tablets are the following:

  • levorin 500 thousand units. It is taken as prescribed by a doctor up to 4 times a day, the course is 10-12 days;
  • nystatin 500 thousand units. It is taken according to the scheme recommended by the doctor up to 5 times a day, the duration of therapy is 10-14 days. To increase the effectiveness of the drug, nystatin intravaginal suppositories are used in parallel;
  • amphoglucamine 200 thousand units. It is taken twice a day, the course is 10-14 days.

Among the effective drugs of local action are:

  • preparations from the group of imidazoles (clotrimazole, ginezol, miconazole, bifonazole, isoconazole, ginalgin) - 1 suppository or 1 dose of cream inside the vagina at bedtime, course - 10 days;
  • polygynax (polymyxin, neomycin, nystatin) 1 suppository in the vagina at night, course duration - 12 days;
  • terzhinan (neomycin, ternidazole, nystatin) - 1 suppository at night, course - 10 days;
  • pimafucort (neomycin, amycin, hydrocortisone) - an ointment or cream is injected into the vagina 2-4 times a day, the course is 2 weeks;
  • betadine - 1 suppository at night, the course lasts up to 2 weeks;
  • meratin combi (neomycin, ornidazole, nystatin) - 1 suppository intravaginally at night, duration of therapy - 10 days.

An important condition for the successful treatment of thrush is the end of the course of therapy only after the doctor is convinced that the causative agent of the disease has been defeated. During the treatment of an acute form of candidiasis, a week after the end of the prescribed course of therapy, the patient's health status is monitored.

During the evaluation of the effectiveness of the treatment of chronic candidiasis, it is necessary to monitor the state of health for 3 months in a row, contacting a doctor on the 1st day after menstruation.

The doctor will take a smear from the vagina to examine the discharge under a microscope, prescribe a culture to determine pathogenic microorganisms and their sensitivity to drugs.

Thrush in women or vulvovaginal candidiasis is one of the most common reasons for them to seek help from a antenatal clinic. Such frequent occurrence is due to the wide prevalence of the pathogen in the environment.

The causative agent of vulvovaginal candidiasis is a fungus of the genus Candida. This conditionally pathogenic microorganism has an oval or rounded shape. Unlike other fungi, they do not form true mycelium, their pseudomycelium is formed by elongation of their own cells, which, adjacent to each other, form chains.

The most favorable conditions for their reproduction are an acidic environment and temperatures from 21 to 37 degrees. Several representatives of the genus are of clinical importance - C.albicans, C.glabrata, C.tropicalis, C.krusei, C.parapsilosis.

Up to 70% of all cases are associated with C.albicans, however, recently the proportion of other pathogens has been increasing. Candida resistance to available antifungal drugs is also on the rise.

The issue of sexual transmission of candidiasis is still debatable. How is it transmitted? Should you treat your sexual partner? The questions are relevant, the answers are different.

The fact is that in the medical literature there is information that in men whose partners are being treated for VVC, the pathogen is found only in 50% of cases.

The remaining 50% are either perfectly healthy or have a different type of fungus.

Therefore, you should know if a woman has a laboratory-confirmed episode of thrush, the sexual partner also needs to take smears and, if the pathogen is detected, undergo treatment.

Treatment is definitely required for men with clinical manifestations - inflammation of the glans penis, itching, swelling, curdled raids.

The sexual partner, of course, can be blamed for the fact that he has become a source of infection, however, this will not be correct. Almost 80% of people first encounter candida in the hospital, getting it from their mother, when passing through the birth canal, or simply from the environment. The fungus settles on the skin and mucous membranes and can peacefully exist there all its life without causing any problems to the owner.

The causes of thrush in women are the most commonplace - a decrease in immunity.

Why is thrush dangerous?

Vulvovaginal candidiasis in women is most often manifested only by lesions of the genitourinary system. In this case, there is no danger to life. Problems can be expected in several cases:

  • lack of adequate treatment, while vast areas are involved in the process, including the skin, which means it becomes a woman’s companion for life;
  • a very strong decrease in immunity and the spread of the infectious process through the lymphatic and blood vessels to other organs and tissues, generalization of the process, sepsis (occurs extremely rarely in very weakened patients);
  • vulvovaginal candidiasis during pregnancy is dangerous by the possibility of spreading the process from the vagina to the uterus, to the fetus (fortunately, it is also rare);
  • thrush during lactation can spread to the nipples, and the risk of affecting the child is also high.

For convenience, let's try to divide the causes of thrush in women into several groups.

External or exogenous causes include:

  1. Influence on the immune system of drugs. When taking hormonal drugs, as well as cytostatics, immunity suppression occurs, the body's ability to adequately respond to an infectious threat decreases.
  2. Women taking combined oral contraceptives. It was previously thought that thrush was provoked by those OKs that contain high doses of estrogens. However, in practice, it all depends on the patient's body - any of the hormonal contraceptives available on the market can lead to the development of candidiasis.
  3. Acute infectious diseases especially those requiring antibiotics. Antibiotics inhibit the growth and reproduction of not only pathogenic microbes, but also normal flora, without affecting fungi and viruses in any way, and in the absence of competition, candida begins to multiply intensively.
  4. Injuries and microtraumas of the vaginal mucosa under the influence of chemical, inflammatory, mechanical factors. If you specify this point, it can be endless - the mucosa is injured during intercourse, when washing with soap and other surfactants, when using spermicides, when STIs enter the body, etc.

Another group of factors contributing to the development of thrush is internal:

  • diseases of the endocrine organs: , thyroid disease with hormonal dysfunction, menstrual irregularities.
  • nutritional factors- insufficient intake of vitamins and microelements with food (anemia, hypo- and beriberi).
  • diseases and functional disorders gastrointestinal tract.
  • pregnancy.

Symptoms of thrush are widely known. The classic course implies the presence of itching, burning, swelling, curdled discharge, pain.

Itching, burning and swelling appear under the action of mediators (biologically active compounds) of inflammation, which, acting on receptors, lead to an increase in the blood supply to the affected tissues, their irritation. Itching and burning worse in the evening, after a long stay on the legs.

The culprits of pain are the same mediators of inflammation. Pain worse after urination, after intercourse. Sometimes it becomes so intense that a woman refuses to have sex at all, which can disrupt her relationship with her partner.

The discharge is most often plentiful, yellow, curdled, of a creamy consistency. Sometimes the discharge is liquid, interspersed with "cottage cheese", with an unpleasant odor.

If the lesion extends to the skin, complaints such as redness, swelling, punctate rash, skin maceration, itching in the perineum, anus appear.

The chronic form of candidiasis is characterized by a process duration of more than 2 months, the main habitual symptoms fade into the background, tissue atrophy and infiltration prevail.

Up to 10% of women may suffer from recurrent vulvovaginal candidiasis. At the same time, clinically pronounced and laboratory-confirmed episodes of thrush are recorded 4 or more times a year.

The most accessible method for diagnosing candidiasis is a microscopic examination of a smear. The sampling is performed by a specialist using a cytobrush or a Volkman spoon, after which the material is applied to a glass slide, dried, fixed and stained in the laboratory and studied under a microscope.

In an acute process, accumulations of yeast cells are found in smears, in a chronic process, accumulations of pseudomycelium.

Currently, the method of express diagnosis of candidiasis is widely used - ready-made test systems are sold in a pharmacy and allow you to confirm or refute the diagnosis in a short time, even at home.

Another fairly affordable, but at the same time troublesome, method is cultural or “sowing”.

Given the difficulties in storing and delivering the material, the long waiting time for the result, the need for a special laboratory, it is resorted to in case of difficulty in making a diagnosis and to obtain the sensitivity of the pathogen to antifungal drugs when standard treatment regimens are ineffective.

PCR diagnostics can also be used to detect a fungus, however, the method is relatively expensive, and very often the question of overdiagnosis arises - you can detect the pathogen in perfectly healthy women who do not require treatment (the method allows you to complete the DNA chain from a small cell fragment).

The treatment of thrush should be handled by a specialist, it should be comprehensive, in compliance with the rules for taking medications.

Self-medication without confirmation of the diagnosis can result in a chronic inflammatory process. Under the mask of thrush, other diseases can be hidden, the treatment of which with antifungal drugs will not have any effect.

As soon as the diagnosis of "vulvovaginal candidiasis" is laboratory confirmed, a treatment regimen is selected. In an acute episode, preference should be given to local forms - suppositories, vaginal tablets, creams. Oral preparations, although they have proven their effectiveness, have a systemic effect, i.e. act on other organs and tissues.

Local medicines are divided into azole derivatives and antifungal antibiotics. The first group includes clotrimazole, miconazole, econazole, butoconazole, isoconazole, ketoconazole. To the second - nystatin and natamycin. Regardless of which drug was prescribed, there is one requirement - a full course of treatment.

The average course of local antifungal agents is 6-7 days, but there are both drugs that require longer use - nystatin, and drugs whose course is limited to a single injection - isoconazole, butoconazole.

The price of antifungal drugs largely depends on the popularity of the manufacturer. In the article, we indicated international common names so as not to single out anyone and not offend anyone.

Of the oral antifungal drugs for the treatment of vulvovaginal candidiasis, azole derivatives - fluconazole and itraconazole, can be prescribed, they are convenient for a short treatment regimen, affordable (the cost again depends on the manufacturer), but are contraindicated in pregnant and lactating women. Itraconazole is also contraindicated in children.

In addition to antifungal drugs, after the main treatment, funds can be prescribed to restore vaginal biocenosis and stimulate immunity. Proper nutrition and intimate hygiene are important.

Widespread and, oddly enough, quite effective. Immediately, of course, we will make a reservation that alternative methods of treatment are good in combination with standard antifungal therapy. They allow you to alleviate the condition, speed up recovery. As monotherapy, alternative methods of treatment are not always effective.

Most often, the vulva and vagina with a soda solution. To do this, you need to dilute a tablespoon of soda in a liter of warm water, mix well and wash 2 times a day, immediately before inserting a candle into the vagina.

Soda is also used for douching, douching is performed with an enema with a soft spout until the discharge is completely washed out. To increase the effectiveness of the procedure, you can add a teaspoon of iodine to soda.

Of the folk methods, infusions of vegetable raw materials - chamomile, calendula, oak bark, birch buds, and so on, have also proved their effectiveness. To prepare the infusion, you need to pour 2 tablespoons of dry raw materials with 1 liter of boiling water. Infuse for thirty minutes in a thermos, cool and use as directed twice a day.

In women, preference should be given to douching or washing, for little girls - sitz baths. Baths are effective for lesions of the labia, vulva.

The duration of the procedure is no more than 5 minutes, twice a day for 7-10 days. Each time the solution is prepared fresh, before immersion, wash the anus with warm water and soap.

Douching is contraindicated for pregnant women and in the first months after childbirth, because. the infection can be thrown into the uterine cavity by the flow of fluid through the cervical canal and spread to its membranes, causing endometritis and infection of the fetus.

Vulvovaginal candidiasis during pregnancy. How to treat?

For the treatment of uncomplicated forms of thrush during pregnancy, preference is given to vaginal forms of antifungal drugs. They are practically not absorbed from the vagina, do not have systemic effects and do not have a harmful effect on the fetus.

From the first trimester, natamycin is allowed, from the second trimester the list expands significantly - clotrimazole, miconazole, butoconazole. Of the complex preparations, terzhinan vaginal tablets are widely used.

Antifungal drugs for oral administration during pregnancy are prescribed only if the infection becomes generalized and can threaten the woman's life.

Prevention of thrush in women

To prevent thrush, a woman must follow the rules of personal hygiene, avoid casual sex, monitor her health and eat right.

It is recommended to limit the use of detergents when caring for the genitals, to abandon synthetic underwear and tight clothing, to minimize the use of panty liners and lubricants.

It is imperative to introduce fiber, fermented milk products into the diet, enrich it with a sufficient amount of vegetables and fruits, it is recommended to exclude fast food, fatty, spicy food, limit sweet and starchy foods, and alcohol.

The incidence of candidal vulvovaginitis over the past 20 years has a clear upward trend. Vulvovaginal candidiasis is now the second most common cause of bacterial vaginosis. From 15 to 40% of infectious lesions of the vulva and vagina are due to a fungal infection. About 75% of women suffer from this disease at least once during their lives. From 40 to 50% of women have relapses of vulvovaginitis, and in 5-8% the disease becomes chronic. The article presents modern data on the etiology, pathogenesis, epidemiology, classification of this pathology. Approaches to diagnostics, clinic of vulvovaginal candidiasis are reflected. The presence of a combined form of vulvovaginal candidiasis and bacterial vaginosis was identified. In the treatment, special attention is paid to the use of the drug clotrimazole as an imidazole derivative in the treatment of vulvovaginal candidiasis. It is noted that clotrimazole is effective against dermatophytes, yeast-like, mold fungi and protozoa. Clotrimazole has an antimicrobial effect against gram-positive (Streptococcus spp., Staphylococcus spp.) and anaerobic bacteria (Bacteroides spp., Gardnerella vaginalis), which makes it possible to use it in combination of vulvovaginal candidiasis with concomitant disorders of the vaginal microbiota.

Keywords: vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis, differential diagnosis, antimycotics, clotrimazole.

For citation: Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V. Vulvovaginal candidiasis: a modern view of the problem // BC. Mother and child. 2017. No. 26. S. 1965-1970

Vulvovaginal candidiasis: modern look at the problem
Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V.
Far Eastern Medical State University, Khabarovsk

The incidence rate of candidal vulvovaginitis has a clear tendency to increase over the past 20 years. Currently, the vulvovaginal candidiasis is on the second place after bacterial vaginosis by the prevalence rate. From 15 to 40% of infectious lesions of the vulva and vagina are caused by a fungal infection. About 75% of women suffer from this disease at least once during their lifetime. From 40% to 50% of women have recurrences of vulvovaginitis, and in 5-8% of women the disease becomes chronic. The article presents modern data on etiology, pathogenesis, epidemiology, classification of this pathology, and reflects approaches to diagnostics and clinical picture of candidiasis vulvovaginitis. The presence of a combined form of candidal vulvovaginitis and bacterial vaginosis is highlighted. In the treatment, special attention is paid to the use of the drug clotrimazole, as an imidazole derivative, in the treatment of vulvovaginal candidiasis. It was noted that clotrimazole is effective against dermatophytes, yeast, molds and protozoa. Clotrimazole has an antimicrobial effect against gram-positive bacteria (Streptococcus spp., Staphylococcus spp.) and anaerobes (Bacteroides spp., Gardnerella vaginalis), which makes it possible to use clotrimazole in vulvovaginal candidiasis combined with concomitant vaginal microbiota disorders.

key words: vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis, differential diagnosis, antimycotics, clotrimazole.
For quote: Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V. Vulvovaginal candidiasis: modern look at the problem // RMJ. 2017. No. 26. P. 1965–1970.

The article presents current data on the etiology, pathogenesis, epidemiology, classification of vulvovaginal candidiasis. In the treatment, special attention is paid to the use of the drug clotrimazole as an imidazole derivative in the treatment of vulvovaginal candidiasis.

Introduction

Vulvovaginal candidiasis (VVC) is an infectious lesion accompanied by inflammation of the vaginal mucosa, which is caused by fungi of the genus Candida. This disease is notable for the fact that normal fungi Candida live in the intestines of a woman and do not harm health. But under certain conditions, mushrooms Candida albicans can replace the normal microflora of a woman's vagina and cause candidal vaginitis / vulvitis.

Codes for the International Classification of Diseases of the 10th revision:

B37. Candidiasis.
B37.3. Candidiasis of the vulva and vagina.
B37.4. Candidiasis of other urogenital localizations.
Q37.9. Candidiasis, unspecified.

Epidemiology

The incidence of VVC over the past 20 years has a clear upward trend. Currently, VVC is the second most common after bacterial vaginosis. A number of authors indicate that VVC is one of the most common reasons for patients to visit a gynecologist. According to various researchers, from 15 to 40% of infectious lesions of the vulva and vagina are caused by a fungal infection. About 75% of women suffer from this disease at least once during their lives. In 40–45% of patients, two (or more) episodes of VVC occur during their lifetime. 10-20% of women are asymptomatic carriers of fungi, with fungi most often localized in the vagina; in pregnant women, fungal colonization can reach 40%.
The prevalence of recurrent forms of candidiasis in the world is about 3 million cases per year. From 40% to 50% of women have relapses of vulvovaginitis, and in 5-8% the disease becomes chronic. The incidence of VVC will continue to increase due to the growth of infection Candida non-albicans(resistant to most antifungal drugs), as well as due to the development of resistance to antifungal drugs.
The prevalence of VVC is not the same in different age groups. The conducted studies have shown that women aged 21 to 40, i.e., the most able-bodied part of society, are more likely to suffer from VVC, which once again indicates the high social significance of this problem. In girls before menarche and in postmenopausal women, the disease is less common. Most researchers believe that the true incidence of VVC is unknown due to the high percentage of self-treatment of patients.

Classification

VVC is divided into uncomplicated and complicated.
Uncomplicated VVC (acute VVC) is diagnosed if all the following criteria are met:
sporadic or infrequent VVC;
mild or moderate VVC;
caused C. albicans;
in immunocompetent patients.
Complicated VVC is diagnosed if at least one of the following criteria is present:
recurrent VVC (diagnosis is made when 4 or more clinically significant episodes of VVC are recorded within 1 year);
severe course of VVC;
candidiasis caused by Candida non-albicans species in patients with reduced immunity (for example, in cases of decompensated diabetes mellitus (DM), treatment with glucocorticoids, pregnancy).
Candidiasis is also distinguished, which is characterized by the absence of complaints from patients and a pronounced clinical picture of the disease. However, microbiological examination of the vaginal discharge reveals a small amount of budding forms of yeast fungi in the absence of pseudomycelium in most cases.

Etiology and pathogenesis

The causative agents of VVC are yeast-like fungi of the genus Candida, numbering more than 170 species, including C. albicans, causing VVC in 75–80% of cases. In recent years, there has been a trend towards an increase in the spread of VVC due to "non-albicans"- types: C. glabrata, C. tropicalis, C. paparsilosis, C. crusei, C. lusitaniae, Saccharomyces cerevisiae. These species of the genus Candida, as a rule, contribute to the complicated course of the disease, which is difficult to respond to antimycotic therapy.
The pathogenesis of VVC is complex and still poorly understood. Considering the fact that strains C. albicans, isolated in patients with vulvovaginal candidiasis and in carriers, do not differ significantly in a number of biochemical characteristics, it can be concluded that the state of the macroorganism plays a leading role in the development of vulvovaginal candidiasis, and not the properties of the pathogen. The trigger for the development of the disease is not a change in the properties of the fungus, but a decrease in the resistance of the host organism.
In the development of candidiasis, the following stages are distinguished:
attachment (adhesion) of fungi to the surface of the mucous membrane with its colonization;
penetration (invasion) into the epithelium, overcoming the epithelial barrier of the mucous membrane, getting into the connective tissue of its own plate, overcoming tissue and cellular defense mechanisms;
penetration into the vessels, hematogenous dissemination with damage to various organs and systems.
With vaginal candidiasis, the infectious process is most often localized in the superficial layers of the vaginal epithelium.

Morphology and physiology of fungi of the genus Candida

Mushrooms of the genus Candida consist of oval budding yeast cells (4–8 µm) pseudohyphae and septate hyphae. For C. albicans characteristic is the formation of a growth tube from the blastospore (kidney) when placed in serum. Besides, C. albicans forms chlamydospores - thick-walled double-circuit large oval spores. On simple nutrient media at 25–27°C, they form yeast and pseudohyphae cells. The colonies are convex, shiny, creamy, opaque. Candida grows in tissues in the form of yeast and pseudohyphae (Fig. 1, 2).

Predisposing factors

Mushrooms of the genus Candida are part of the normal microflora of the vagina. However, under the influence of certain exogenous and endogenous factors (broad-spectrum antibiotics, immunodeficiency states, human immunodeficiency virus, tuberculosis, diabetes mellitus, thyroid pathology, sexually transmitted infections, etc.), candidiasis passes into a clinically pronounced form (Fig. 3 ).
Genital candidiasis is often accompanied by asymptomatic candidouria, urethritis, and other urinary tract diseases. In the pathogenesis of genital candidiasis, a certain role is played by the long-term use of hormonal (oral) contraceptives, which affect the ratio of hormones that regulate reproductive function. Virulence C. albicans increases in conditions of high humidity (sweating). Triggers for the development of hypersensitivity and predisposition to colonization of fungi of the genus Candida are:
wearing tight synthetic underwear
washing with a shower under pressure,
use of sprays
use of gaskets (Fig. 3) .

Screening

Patients with complaints of cheesy vaginal discharge, itching, burning, dyspareunia, and pregnant women are subject to examination for VVC. Screening is done by microscopic examination of a vaginal discharge.

Diagnostics

Clinical picture

The clinical picture of VVC varies and depends on a number of factors, including the type of pathogen. The most common symptoms of VVC include the following clinical signs:
copious discharge from the genital tract of various colors and consistency: white, thick (creamy) or flaky, cheesy, membranous, with a mild sour smell, occasionally watery, with curdled crumbly inclusions;
itching and burning in the vagina and vulva; itching, usually intense, accompanied by scratching, often leads to insomnia, neuroses;
hyperemia, edema, rashes in the form of vesicles on the skin and mucous membranes of the vulva and vagina;
the above symptoms can often interfere with urination, causing urinary retention.
Recurrent VVC is diagnosed in the presence of 4 or more episodes of VVC per year, occurs in 17–20% of women with VVC. There are 2 main mechanisms for the occurrence of chronic recurrent candidiasis:
reinfection of the vagina;
relapse associated with incomplete elimination of the pathogen.
The clinical picture in recurrent VVC is characterized by a lower prevalence of lesions, less intense hyperemia and swelling; vaginal discharge is less abundant or may be absent. On the skin and mucous membranes of the genital organs, secondary elements predominate in the form of infiltration, lichenification, and tissue atrophy. In addition, the process can extend to the perianal region, as well as to the inner thighs. As a rule, the symptoms of the disease develop rapidly a week before menstruation and subside slightly during menstruation (Table 1).


The consequence of the complicated form of VVC are:
generalized candidiasis in patients with immunodeficiency conditions;
recurrent infections of the urinary system;
miscarriage;
the birth of small children;
chorioamnionitis;
premature rupture of membranes;
premature birth.

Laboratory and instrumental research

Diagnosis of VVC should be comprehensive. The leading role in the diagnosis, along with clinical symptoms, belongs to microbiological research methods (microscopy of smears of vaginal discharge and cultural research), the diagnostic value of which reaches 95%. The cultural method - sowing material on a nutrient medium allows you to determine the number, generic and species of fungi, their sensitivity to antifungal drugs, as well as the nature and degree of microbial contamination with other opportunistic bacteria. Microscopic examination is one of the most accessible and simple diagnostic methods. The study is carried out in native and Gram-stained preparations. In recent years, express diagnostic methods have been used, which, in the shortest possible time, with fairly high accuracy, make it possible to identify fungal strains using ready-made test systems with favorable media for fungal growth. The use of express diagnostics is very promising, does not require much time, does not cause difficulties, however, its results do not allow one to judge the accompanying flora.
In severe, recurrent forms of VVC, accompanied by disorders in the immune system, it is possible to determine the titers of antibodies to fungi of the genus Candida in blood serum. But this research method is practically not used due to the high frequency of false negative and false positive results.
Colposcopic diagnostic method is not specific. It reveals changes in the epithelium characteristic of the inflammatory process, but does not allow determining the etiology of the disease.
Molecular biological methods (real-time polymerase chain reaction (PCR) aimed at detecting specific fragments of deoxyribonucleic acid or ribonucleic acid Candida spp..) are not obligatory methods of laboratory diagnostics of VVC.
Depending on the concentration of yeast-like fungi of the genus Candida and the nature of the accompanying microflora in the vaginal biotope, there are 3 forms Candida vaginal infections:
asymptomatic carriage;
true candidiasis (a high concentration of fungi is combined with a high concentration of lactobacilli);
a combined form of bacterial vaginosis with VVC (fungi vegetate with an overwhelming predominance of obligate anaerobes).

Differential Diagnosis

It is advisable to carry out differential diagnosis of VVC with:
bacterial vaginosis;
genital herpes;
aerobic vaginitis;
skin diseases (eczema, lichen planus, scleroderma, Behçet's disease, etc.).
In clinical practice, most often, differential diagnosis of VVC should be carried out with bacterial vaginosis and trichomoniasis (Table 2). Differential diagnosis of vaginal pathology is presented in Table 2.

Treatment

The goal of medical treatment of VVC is the eradication of the pathogen. Most VVC cases respond to topical antifungals and antiseptics.
The advantages of topical agents include their safety, high concentrations of antimycotics created on the surface of the mucous membrane, and a lower likelihood of developing resistance. In addition, many local antimycotics provide relief of symptoms faster, mainly due to the ointment base. With severe symptoms of the disease, preference is given to systemic drugs.
Among systemic drugs, fluconazole is used, which was previously prescribed once in the treatment of VVC, subsequently the drug was recommended to be used three times. In the treatment of VVC caused by fungi Candida non-albicans, the prevalence of which has been steadily increasing recently, the use of fluconazole is ineffective. In this regard, the relevance of the use of other groups of antifungal drugs, including clotrimazoles, is increasing.
Local antifungal agents are produced in special forms: vaginal suppositories and tablets, creams, solutions for douching. The arsenal of vaginal forms of antimycotics in Russia is constantly changing, which sometimes misleads doctors about currently available drugs. In Russia, vaginal forms of isoconazole, clotrimazole, miconazole, econazole, etc. are registered.
Vaginal creams are recommended for the treatment of vulvitis, a combination of vulvitis and vaginitis, tablet forms and suppositories for the treatment of vaginitis. The drugs are usually administered at bedtime using the supplied applicators (creams) or fingertips (suppositories).
Intravaginal and oral administration of drugs is equally effective (level of evidence ΙΙ, class A). However, local forms are safer, since they practically do not have a systemic effect and create high concentrations of the active substance at the site of application.
The following main antifungal drugs are used:
polyene series (natamycin, nystatin);
imidazole series (clotrimazole, sertaconazole, ketoconazole, butoconazole, fenticonazole, miconazole, econazole, omoconazole, ternidazole, etc.);
triazole series (fluconazole, itraconazole);
others (iodine preparations, etc.).
Despite the rapid development of the pharmacological industry and a huge selection of antimycotic drugs, the problem of treating vulvovaginal candidiasis does not lose its relevance. Considering the high frequency of the disease, the long course, and frequent recurrence of the process, it can be assumed that, most likely, an unreasonable approach to the diagnosis and treatment of this disease is the basis. The causative agent of chronic recurrent vulvovaginitis in 85% of cases is a mixed candidal infection resistant to widely used antimycotic agents. In this regard, the use of antimycotic drugs, which also have an antimicrobial effect on the accompanying microbial flora, is of fundamental importance. An example of such a drug is clotrimazole (imidazole series), which is effective against dermatophytes, yeasts, molds and protozoa. Has antimicrobial activity against gram-positive ( ) and anaerobes ( ). Clotrimazole has no effect on lactobacilli. In vitro, at a concentration of 0.5–10 μg / ml, clotrimazole inhibits the reproduction of bacteria of the Corinebacteria family and gram-positive cocci (with the exception of enterococci); has a trichomonacid effect at a concentration of 100 μg / ml.
When using clotrimazole intravaginally (tablets - 100, 200, 500 mg; suppositories - 100 mg), absorption is 3-10% of the administered dose. High concentrations in the vaginal secretion and low concentrations in the blood persist for 48-72 hours. It is metabolized in the liver to inactive metabolites, excreted from the body by the kidneys and through the intestines.
Clotrimazole 2% cream (10 mg) used for external use, due to the action of the active substance (clotrimazole), penetrates into the fungal cell and disrupts the synthesis of ergosterol, which is part of the fungal cell membrane, which changes the permeability of the membrane and causes subsequent cell lysis. In fungicidal concentrations, it interacts with mitochondrial and peroxidase enzymes, resulting in an increase in the concentration of hydrogen peroxide to a toxic level, which also contributes to the destruction of fungal cells. Similarly, clotrimazole acts on pathogenic bacteria (gram-positive ( Streptococcus spp., Staphylococcus spp..) microorganisms and anaerobes ( Bacteroides spp., Gardnerella vaginalis)), which cause vulvitis and vaginitis.
The advantage of using Clotrimazole 2% cream over other forms of antimycotics is that this form is effective in the treatment of recurrent candidal vulvitis with the addition of a bacterial infection in women, as well as for the treatment of balanoposthitis in their sexual partners, due to the antimicrobial effect of the drug. Treatment with Clotrimazole (2% cream) for men should be started immediately when the first symptoms of the disease appear. A neglected infection can develop into a chronic form or provoke serious consequences - the appearance of prostatitis and vesiculitis. In some cases, fungi can infect the bladder and kidneys.
In addition, it is advisable to use Clotrimazole 2% cream in the treatment of vulvitis in HIV-infected patients and patients with diabetes mellitus due to the frequent presence of severe forms of recurrent VVC in these patients.
The advantages of Clotrimazole 2% cream over 1% cream are a higher concentration of the active substance at the site of application and, therefore, a reduction in the duration of the course of treatment - 2% cream is used to treat VVC 1 time per day for 3 days, 1% cream - 1 once a day for 7 days.
The main advantages of Clotrimazole over other antifungal agents are:
effective effect on pathogenic forms of fungi and the accompanying bacterial flora - gram-positive ( Streptococcus spp., Staphylococcus spp.) and anaerobes ( Bacteroides spp., Gardnerella vaginalis), clotrimazole inhibits the reproduction of bacteria of the family corinebacteria and gram-positive cocci (with the exception of enterococci); has a trichomonacid effect, leading to the death of trichomonads and, accordingly, to a complete cure for the disease;
the minimum number of contraindications for use and side effects, which is associated with the local use of clotrimazole;
economic availability of the drug.

Basic preventive measures

Recovery will be facilitated by continuous VVC prophylaxis, which should include the following recommendations for patients:
use a barrier method of protection (condom) during sexual intercourse; it is especially important to follow this rule for women who do not have a permanent sexual partner;
conduct an examination of the body and identify hidden diseases (especially the genitourinary system);
refuse to have sexual contact with a person with candidiasis until he recovers;
treat the underlying disease that provoked a decrease in immunity;
if possible, abandon hormonal contraceptives, under the influence of which the hormonal background becomes a favorable basis for the growth of fungi;
when treating with antibiotics, additionally use antimycotic drugs;
refuse, at least partially, from underwear made of synthetic materials;
observe the hygiene of intimate places;
give up strict diets and eat rationally;
do not abuse alcohol, stop smoking.

Observation and follow-up

The criteria for the effectiveness of VVC treatment is the disappearance of the symptoms of the disease in combination with negative results of a microbiological study.

Forecast

The prognosis is favorable.

Literature

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16. Paulitsch A., Weger W., Ginter-Hanselmayer G. et al. A 5-year (2000–2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria // Mycoses. 2006 Vol. 49(6). P. 471–475.
17. Shi W.M., Mei X.Y., Gao F. et al. Analysis of genital Candida albicans infection by rapid microsatellite markers genotyping // Chin. Med. J. 2007. Vol. 120(11). R. 975–980.
18. Guzel A.B., Ilkit M., Akar T. et al. Evaluation of risk factors in patients with vulvovaginal candidiasis and the value of chrom ID Candida agar versus CHRO Magar Candida for recovery and presumptive identification of vaginal yeast species // Med. Mycol. 2011 Vol. 49(1). P. 16–25.
19. Bozek A., Jarzab J. Epidemiology of IgE-dependent allergic diseases in elderly patients in Poland // Am J Rhinol Allergy. 2013. Vol. 27(5). P. 140–145.
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22. Pestrikova T.Yu., Yurasov I.V., Yurasova E.A. Inflammatory diseases in gynecology. M.: Litterra, 2009. 256 p. .
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Most women have experienced vulvovaginal candidiasis at least once in their lifetime. In 40–45% of patients, the disease recurs, and 5% of women suffer from a chronic form of pathology.

Many underestimate the danger of a fungal infection and ignore its first symptoms. Without adequate treatment, the disease progresses and reduces the quality of life. Pathogenic microorganisms spread to healthy tissues and create new lesions. The longer vulvovaginal candidiasis develops, the more difficult it is to cure.

About the disease

Vulvovaginal candidiasis is an infectious disease that is accompanied by inflammation of the mucous membrane of the vulva, vagina, urethra and perineal skin. Its causative agents are yeast-like fungi of the genus Candida. Vulvovaginal candidiasis most often causes the appearance. From 80 to 92% of episodes of pathology falls on its share. In other cases, representatives are identified:

  • C. glabrata;
  • C. tropicalis;
  • C. guillermondii;
  • C. parapsilosis;
  • C. Kefir.

Cells of fungal microorganisms have a rounded shape. Their sizes range from 1.5 to 10 microns. Yeast-like fungi create pseudomycelium, which is formed by elongation of their cells. The causative agents of the disease are anaerobes. These are organisms that require oxygen to support the process of energy synthesis. Candida fungi actively multiply in conditions of high humidity and at a temperature of 20-37 ° C. The most favorable pH level for them is 6.0–6.5.

Yeast-like fungi Candida are widely distributed in nature. They are found in vegetables, fruits, dairy products, as well as on the surfaces of objects. They are resistant to adverse conditions. Fungal microorganisms die only after prolonged boiling (10–30 minutes). They remain viable for half an hour, being under the influence of dry steam with a temperature of 95–110 ° C. Fungi can withstand a very acidic environment (pH 2.5-3.0) for a long time, although under such conditions their development is slowed down.

According to the nature of the course, vulvovaginal candidiasis is divided into acute and chronic. The first form of the disease lasts no more than 2 months. Chronic pathology can be recurrent and persistent. The first is periodically aggravated - at least 4 episodes per year. Between them, the woman feels completely healthy. In the persistent form, the symptoms of the disease are observed constantly, sometimes decreasing, sometimes increasing.

Fungal infection most often develops in women of reproductive age. The peak incidence occurs at the age of 20–45 years.

Reasons for development

Candida fungi are considered opportunistic microflora. They are present in small amounts on the skin and mucous membranes of healthy people, without causing the development of diseases. Fungal microorganisms are essential. They help to dispose of dead and dangerous cells.

The number of colonies of fungal flora is controlled by immunity and beneficial bacteria that are part of the human microbiocenosis. Therefore, healthy people rarely encounter fungal diseases and do not know what it is.

Uncontrolled medication intake

Pathogenic properties of Candida fungi acquire when the immune system weakens or the number of beneficial microorganisms is sharply reduced.

The widespread use of fungal infection contributes to the mass use of:

  • antibiotics;
  • cytostatics;
  • immunosuppressants;
  • hormonal drugs (especially the first generation);
  • oral contraceptives.

Non-compliance with personal hygiene

The development of the disease is provoked by vaginal tampons and sanitary pads. Because of them, a favorable environment for the reproduction of fungal microorganisms is created in the perineal area.

Pregnancy

Pregnancy affects the development of a fungal disease. During childbearing, the likelihood of vulvovaginal candidiasis increases by 2-3 times. The main causes of the disease include an increase in the concentration of estrogens and progestins in the tissues.

Recurrent forms of vulvovaginal candidiasis often develop against the background of impaired carbohydrate metabolism in patients with diabetes mellitus. They are characterized by frequent exacerbations and are difficult to treat.

Chronic vulvovaginal candidiasis is often the result of self-medication. Advertising of antimycotic drugs and their availability cause uncontrolled intake of medications.

Incorrectly selected drugs do not suppress the reproduction of pathogens, while weakening the body's defenses.

Severe forms of vulvovaginal candidiasis result from poor patient compliance. This term refers to the degree of patient compliance with the recommendations of the doctor. If the patient arbitrarily reduces the course of treatment and reduces the dosage of drugs, fungal microorganisms survive and become resistant to the drug. In this case, it becomes more difficult to achieve a therapeutic effect.

Characteristic symptoms

The acute form of vulvovaginal candidiasis is characterized by pronounced symptoms. The woman is tormented by unbearable itching in the vulva and vagina. It intensifies in the evening, at night, and also after a long walk. The itching is so severe that the patient cannot refrain from scratching.

As a result, micro-wounds appear on the mucous membrane, through which pathogens penetrate deep into the tissues. Due to severe itching, which can also occur in the anus, sleep is disturbed and neuroses develop.

In addition to itching in the genital area, burning and pain are noted, especially in the area of ​​scratching. Unpleasant sensations intensify in the process of urination, preventing the complete emptying of the bladder.

Excruciating itching, burning and pain accompany sexual intercourse. Over time, a woman develops a fear of sexual contact.

A characteristic sign of vulvovaginal candidiasis is the appearance of whites (leukorrhea). They may have a thick (creamy) or flaky consistency. Gray-white discharge is a bit like cottage cheese and has a mild sour smell. Sometimes they are watery with curdled clots that look like crumbs. In some cases, the disease proceeds without the formation of whites.

The skin in the lesion reddens, swells and softens. On it you can find small red nodules and raids of gray-white color of a rounded or oval shape. The size of cheesy spots with a sour smell can reach 5-7 mm in diameter. They can merge into large formations with clear boundaries, surrounded by areas of strongly reddened mucous membrane. They contain a huge amount of rapidly multiplying Candida fungi.

If candidiasis is diagnosed in the acute stage, it is difficult to remove plaque. Under them, a bleeding eroded surface is exposed. In the chronic form of the disease, it is easy to get rid of curdled films. After removing plaque from the tissues of the mucous membrane, a whitish curdled liquid is abundantly released.

Symptoms usually occur a week before your period. During bleeding, they appear less intensely.

In the chronic form of the disease, the mucous membrane of the genital organs becomes thick, dry and rough. Areas with signs of atrophy appear on it.

Treatment of the disease

At the initial stage of the disease, drugs with antimycotic action and antiseptics for external use are used. They allow you to create a high concentration of the active substance in the lesion, minimally affecting the entire body.

If vulvar candidiasis is diagnosed, creams are used. When the mucous membrane of the vagina is affected, suppositories, solutions and vaginal tablets are used.

During pregnancy, it is allowed to use antimycotic agents in the 2nd and 3rd trimester, giving preference to topical preparations. Systemic drugs are prescribed in extreme cases, when the benefit to the mother outweighs the potential harm to the fetus.

Polyenes are used to treat fungal infections:

  • Nystatin;
  • Levorin;
  • Amphotericin.

Imidazoles:

  • Isoconazole;
  • Ketoconazole;
  • Bifonazole;
  • Miconazole;
  • Clotrimazole.

Triazoles:

  • Fluconazole;
  • Itraconazole.

Fluconazole is considered the "gold standard" for the treatment of vulvovaginal candidiasis. Fungi of the species Candida albicans are especially sensitive to it.

The lesions are treated with antiseptic solutions (baking soda, boric acid, potassium permanganate). They are used for baths, douching or for wetting vaginal tampons. The doctor applies aniline dyes to the vaginal mucosa.

Showing antiseptic preparations in the form of suppositories (Betadine, Vokadine, Yodoxide). They are administered at bedtime. Boric acid can be prescribed in the form of vaginal capsules. In severe cases, hormonal creams (class 1 and 2 corticosteroids) are used.

Treatment of fungal infections is difficult due to the rapidly developing resistance of pathogens to drugs. Fungal cells mutate and produce enzymes that reduce their exposure to the drug. They acquire "pumps" that literally eject the active substance from the cells.

In order to overcome the problem of resistance of pathogenic microorganisms, a fundamentally new antimycotic drug Sertaconazole has been created. Its molecule contains azole and benzothiafene structures that reinforce each other. A single application of Sertaconazole for external use in the form of suppositories or cream is recommended.

Treatment of complicated forms of vulvovaginal candidiasis

Often, a fungal disease is complicated by a bacterial infection. In such cases, the treatment of vulvovaginal candidiasis is carried out with complex preparations containing, in addition to antimycotic, antibacterial, hormonal or antiseptic substances.

The Macmirror drug contains the antimycotic Nystatin and the antibacterial agent Nifuratel. Macmirror is used externally and in the form of candles.

The combination of antimycotics with Metronidazole has been substantiated. It is active against bacteria and protozoa. For the treatment of vulvovaginal candidiasis, the Neo-Penotran complex preparation is used in the form of vaginal suppositories. They contain miconazole and metronidazole.

Combined agents are successfully used: Travocort (Isaconazole nitrate + Difluorocortolone-21-valerate), (Miconazole + Metronidazole), Polygynax (Nystatin + Neomycin + Polymyxin) and Terzhinan (Nystatin + Neomycin sulfate + Ternidazole + Prednisolone).

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