Vaginal yeast infection

in candidal vulvovaginitis, showing thick, curd-like plaque on the anterior vaginal wall. A slightly erythematous base is visible close to the center of the image, where some of the plaque was scraped off. The symptoms of vaginal thrush include vulval itching, vulval soreness and irritation, pain or discomfort during sexual intercourse (superficial dyspareunia), pain or discomfort during urination (dysuria) and vaginal discharge, which is usually odourless. Although the vaginal discharge associated with yeast infection is often described as thick and lumpy, like paper paste or cottage cheese, it can also be thin and watery, or thick and of uniform texture. As well as the above symptoms of thrush, vulvovaginal inflammation can also be present. The signs of vulvovaginal inflammation include erythema (redness) of the vagina and vulva, vaginal fissuring (cracked skin), edema (swelling from a build-up of fluid), also in severe cases, satellite lesions (sores in the surrounding area). This is rare, but may indicate the presence of another fungal condition, or the herpes simplex virus (the virus that causes genital herpes). ==Causes and risk factors==

Medications Infection occurs in about 30% of women who are taking a course of antibiotics by mouth. Oral contraceptive use is also associated with increased risk of vaginal thrush. Lifestyle While infections may occur without sex, a high frequency of intercourse increases the risk. as with HIV/AIDS, or in those receiving chemotherapy. Diet A diet high in sugar may increase the risk of vaginal thrush; This increases the risk of both bacterial vaginosis and yeast infection. Application of estradiol cream to the vagina prevents this, although men may have concerns about this treatment due to the administration of estrogen. == Species of yeast responsible ==

While Candida albicans is the most common yeast species associated with vaginal thrush, infection by other types of yeast can produce similar symptoms. A Hungarian study of 370 patients with confirmed vaginal yeast infections identified the following types of infection: • Candida albicans: 85.7% • Non-albicans Candida (8 species): 13.2% • Saccharomyces cerevisiae: 0.8% • Candida albicans and Candida glabrata: 0.3% Non-albicans Candida are often found in complicated cases of vaginal thrush in which the first line of treatment is ineffective. These cases are more likely in those who are immunocompromised. ==Diagnosis==

in candidal vulvovaginitis, showing slings of pseudohyphae of Candida albicans. A chlamydospore is visible at left. Vulvovaginal candidosis is the presence of Candida in addition to vaginal inflammation. Complicated Complicated thrush is four or more episodes of thrush in a year or when severe symptoms of vulvovaginal inflammation are experienced. It is also complicated if coupled with pregnancy, poorly controlled diabetes, poor immune function, or the thrush is not caused by Candida albicans. Because vaginal and gut colonization with Candida is commonly seen in women with no recurrent symptoms, recurrent symptomatic infections are not simply due to the presence of Candida organisms. There is some support for the theory that RVVC results from an especially intense inflammatory reaction to colonization. Candida antigens can be presented to antigen-presenting cells, which may trigger cytokine production and activate lymphocytes and neutrophils that then cause inflammation and edema. PRA1 gene (pH-regulated antigen) is strongly up-regulated during vaginal infections, which correlates with inflammation. ==Treatment==

The following treatments are typically recommended: • Intravaginal (vaginal suppository): butoconazole, clotrimazole, miconazole, nystatin, tioconazole, terconazole. All are more or less equally effective. • By mouth: ibrexafungerp, fluconazole as a single dose. Recurrent For infrequent recurrences, the simplest and most cost-effective management is self-diagnosis and early initiation of topical therapy. However, women whose condition has previously been diagnosed with candidal vulvovaginitis are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an over the counter preparation, or who has a recurrence of symptoms within two months, should be evaluated with office-based testing. Other treatments after more than four episodes per year, may include ten days of either oral or topical treatment followed by fluconazole orally once per week for six months. Non-albicans species tend to have higher levels of resistance to fluconazole. Therefore, recurrence or persistence of symptoms while on treatment indicates speciation and antifungal resistance tests to tailor antifungal treatment. Alternative medicine Up to 40% of women seek alternatives to treat vaginal yeast infection. Probiotics (either as pills or as yogurt) do not appear to decrease the rate of occurrence of vaginal yeast infections. No benefit has been found for active infections. There is no evidence to support the use of special cleansing diets and colonic hydrotherapy for prevention. ==Prevention==

Zinc gel can prevent reinfections. ==Epidemiology==

The number of cases of vaginal yeast infection is not entirely clear because it is not a reportable disease and it is commonly diagnosed clinically without laboratory confirmation. Candidiasis is one of the three most common vaginal infections along with bacterial vaginosis and trichomonas. About 75% of women have at least one infection in their lifetime, 40%–45% will have two or more episodes, and approximately 20% of women get an infection yearly. == Research ==

Vaccines that target C. albicans are under active development. Phase 2 results published in June 2018 showed a safe and high immunogenicity of the NDV-3A vaccine candidate. == Pathogenisis in Vulvodynia ==

There is a causal link between severe and or recurrent vulvovaginal candidiasis and vulvodynia – a chronic pain condition. The UK Vulval Pain Society highlights: "Some women have a sudden onset of symptoms following a specific event: a commonly recognised event is a severe attack of thrush followed by anti-thrush treatment. Once the attack of thrush settles following treatment, soreness and burning may persist as vestibulodynia". Research on mouse models has found that giving females repeated Candida infections leads to chronic pain in their vulva. Insults to the highly innervated vulval vestibule lead to hyperalgesia in a process thought to be similar to post-herpetic neuralgia. In some patients, a process of neuroproliferation occurs in which the vestibule grows 10x as many nerves as healthy controls. == References ==