Vaginal candidiasis

Alternative names
Yeast infection - vagina; Vaginal yeast infection; Monilial vaginitis

Definition
This is a vaginal infection caused most commonly by the fungal organism Candida albicans.

Causes, incidence, and risk factors

Candida albicans is a widespread organism with worldwide distribution. It is normally found in small amounts in the vagina, the mouth, the digestive tract, and on the skin without causing disease or symptoms (approximately 25% of women without disease symptoms have this organism present).

Symptoms appear when the balance between the normal microorganisms of the vagina is lost, and the Candida albicans population becomes larger in relation to the other microorganism populations.

This happens when the environment (the vagina) has certain favorable conditions that allow growth and nourishment of Candida albicans. An environment that makes it difficult for the other microorganisms to survive may also cause an imbalance and lead to a yeast infection.

Yeast infection may follow a course of antibiotics (particularly tetracycline) that were prescribed for another purpose. The antibiotics change the normal balance between organisms in the vagina by suppressing the growth of protective bacteria that normally have an antifungal effect.

Infection is common among women who use estrogen-containing birth control pills and among women who are pregnant. This is due to the increased level of estrogen in the body. The increased hormone level causes changes in the vaginal environment that make it perfect for fungal growth and nourishment.

Yeast infections may also occur in association with diabetes or problems that affect the immune system (such as AIDS or HIV).

Vaginal candidiasis is not considered a sexually transmitted disease. However, 12% to 15% of men will develop symptoms such as itching and penile rash following sexual contact with an infected partner.

Close attention should be paid to episodes of vaginal candidiasis. Repeat infections that occur immediately following therapy, or a persistent yeast infection that does not respond to therapy, may be the first or, at least, an early sign that an individual is infected with HIV.

Both males and females with HIV infection who have developed AIDS may be subject to disseminated infection with candida, including oral candidiasis (in the mouth), esophageal candidiasis (in the esophagus), and cutaneous candidiasis (on the skin).

Symptoms

     
  • Abnormal vaginal discharge       o Ranges from a slightly watery, white discharge to a thick, white, chunky discharge (like cottage cheese)  
  • Vaginal and labial itching, burning  
  • Redness and/or inflammation of the vulvar skin  
  • Pain with intercourse  
  • Urination, painful

Signs and tests

A pelvic examination will be performed. It may show inflammation of the skin of the vulva, within the vagina, and on the cervix. The examining physician may find dry, white plaques on the vaginal wall.

A wet prep (microscopic evaluation of vaginal discharge) shows Candida.

Treatment

Generally, the first incidence of yeast infection should be treated by your health care provider.

After the first infection, if a second infection occurs and is unquestionably a yeast infection, self-treatment may be initiated with over-the-counter vaginal creams such as miconazole or clotrimazole. Persistent symptoms should be evaluated by your gynecologist or primary health care provider.

Cranberry juice and yogurt are two foods that may help prevent the occurrence of yeast infections and aid in their treatment.

Medications for vaginal yeast infections are available in either vaginal cream/suppositories or oral preparations. The use oral preparation should be avoided during pregnancy.

Expectations (prognosis)

The symptoms usually disappear completely with adequate treatment.

Complications

Chronic or recurrent infections may occur. This may be from inadequate treatment or self-reinfection.

Secondary infection may occur. Intense or prolonged scratching may cause the skin of the vulva to become cracked and raw, making it more susceptible to infection.

Calling your health care provider

Call for an appointment with your health care provider if this is the first time that vaginal yeast infection symptoms have occurred, or if you are unsure if you have a yeast infection. (If you are sure that you have a yeast infection, you can treat the disorder with over-the-counter medications.)

Call your health care provider if symptoms are unresponsive to self-treatment with recommended vaginal creams, or if other symptoms are present.

Prevention

Avoid persistent and excessive moisture in the genital area by wearing underwear or pantyhose with cotton crotches, and loose fitting slacks. Avoid wearing wet bathing suits or exercise clothing for long periods of time, and wash them after each use.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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