Vulvovaginitis, candidal
Vulvovaginitis (also Vulvitis) 616.10
Vulvovaginitis, amebic 006.8
Vulvovaginitis, chlamydial 099.53
Vulvovaginitis, gonococcal (acute) 098.0
Vulvovaginitis, gonococcal, chronic or duration of 2 months or over 098.2
Vulvovaginitis, herpetic 054.11
Vulvovaginitis, monilial 112.1
Vulvovaginitis, trichomonal (Trichomonas vaginalis) 131.01
DESCRIPTION
Vulvar pruritus and/or burning, often with abnormal vaginal discharge
System(s) affected: Reproductive, Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA:
40% of vulvovaginitis is caused by Candida
16% of non-pregnant premenopausal women are asymptomatic carriers
Predominant age: Menarche to menopause
Predominant sex: Female only
SIGNS AND SYMPTOMS
Intense vulvar itching
Thick curd-like vaginal discharge
Dyspareunia at times
Erythema of vulva
Erythema, pain and pruritus of crural and perineal area
Thick white patches appear attached to vaginal mucosa
Inflamed vulvar skin
CAUSES
Overgrowth of Candida species (C. albicans, C. glabrata, C. tropicalis) in vagina
RISK FACTORS
Pregnancy
Diabetes mellitus
Antibiotic therapy
Corticosteroid therapy
Immunosuppressed states
HIV infection
Occlusive synthetic underpants and undergarments
Hypothyroidism
Oral contraceptive medications (low dose usually not a cause of increased infection risk)
Anemia
Zinc deficiency
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
Trichomonas vaginitis
Gonorrheal vaginitis - in prepubertal girls
Pinworm vaginitis
Contact dermatitis/vaginitis
LABORATORY
Yeast, spores, and/or pseudohyphae on smear with 10% KOH solution
Culture findings on Nickerson’s or Sabouraud’s media; usually only indicated for recurrent infections
Vaginal pH < 4.5
DIAGNOSTIC PROCEDURES
Smear of discharge with 10% KOH solution
Pap smear
TREATMENT
APPROPRIATE HEALTH CARE
Outpatient
GENERAL MEASURES
Remove foreign body if one present
Consider povidone-iodine (Betadine, Operand) douche 15 to 30 mL/L (2 tbsp/qt) of water for symptomatic relief until specific therapy is effective
If urination causes burning, have the patient
- Urinate through a tubular device such as a toilet-paper roll or plastic cup with the end cut out
- Pour warm water over vaginal area while urinating
Insist on strict diabetic control if patient is diabetic
ACTIVITY
Avoid overexertion, heat, and excessive sweating
Delay sexual relations until symptoms clear
DIET
Limit sweets (sucrose) and dairy products (lactose) in recurrent infections
PATIENT EDUCATION
Keep the genital area clean. Use plain unscented soap.
Take showers rather than tub baths
Wear cotton underpants with a cotton crotch. Avoid clothing made from non-ventilating materials, including most synthetic underclothing. Avoid tight-fitting jeans or slacks
Sleep in loose gown without underpants
Don’t sit around in wet clothing - especially a wet bathing suit
Avoid frequent douches
Avoid broad-spectrum antibiotics when possible
After urinating or bowel movements, cleanse by wiping or washing from front to back (vagina toward anus)
Lose weight, if obese
American College of Obstetricians & Gynecologists (ACOG), 409 12th St., SW, Washington, DC 20024-2188, (800)762-ACOG
MEDICATIONS
DRUGS OF CHOICE
Fluconazole (Diflucan): 150 mg po once
Miconazole nitrate (Monistat): one suppository q night x 3, or miconazole vaginal cream q night x 7, or
Butoconazole nitrate (Femstat): vaginal cream q night x 3, or
Terconazole (Terazol): one suppository or vaginal cream q night x 3, or
Clotrimazole (Gyne-Lotrimin): two 100 mg tablets intravaginally x 3 days or cream each night x 7 days
Contraindications: N/A
Precautions:
Use fluconazole with caution in patients with liver disease
Significant possible interactions: Refer to manufacturer’s profile of each drug
ALTERNATIVE DRUGS
Retreat with different agent, if recurrence
Course of oral nystatin; 100,000 units tid for 2 weeks
Topical gentian violet 1% aqueous solution painted onto vagina weekly until infection resolves (usually 2-3 weeks)
Boric acid 600 mg in gelatin capsule inserted vaginally daily for 2 weeks.
FOLLOWUP
PATIENT MONITORING
Generally no specific followup needed. If symptoms persist, then repeat pelvic exam and culture.
PREVENTION/AVOIDANCE
Follow instructions under patient education
For recurrences consider reinfection from sexual partner(s). Examine and treat sex partner for Candida balanitis and oral Candida if vaginitis recurs.
Review Risk Factors
POSSIBLE COMPLICATIONS
Secondary bacterial infections of the vagina or vulva
EXPECTED COURSE/PROGNOSIS
Complete cure with vigorous treatment
Recurrences are common
MISCELLANEOUS
ASSOCIATED CONDITIONS
Sexually transmitted diseases
AGE-RELATED FACTORS
Pediatric: Less common before puberty
Geriatric: N/A
Others: N/A
PREGNANCY
Common
SYNONYMS
Monilial vulvovaginitis
ICD-9-CM
112.1 Candidiasis of vulva and vagina
Author(s)
Albert T. Shiu, MD
Provided by ArmMed Media
Revision date: July 6, 2011
Last revised: by Tatiana Kuznetsova, D.M.D.
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