GENITAL CANDIDAL INFECTION

Definition:

 Symptomatic overgrowth of commensal yeasts on the mucosa of the

vagina or penis
 Fungal or yeast infections account for 30 to 35% of vaginal infections;
most of them are due to Candida albicans.
 Yeast colonizes 15 to 20% of nonpregnant and 20 to 40% of pregnant
women.

Etiology

 Yeast infections of the genital tract, usually caused by Candida albicans,

are very common in women but usually are not acquired sexually

Risk factors:

 Diabetes,
 Use of IUDs,
 Oral contraceptives
 Pregnancy,
 Recent use of an antibiotic (e.g. tetracycline for acne)
 Use of corticosteroids regularly,
 Immunodeficient.

Symptoms and Signs

 Typical symptoms include vaginal pruritus--with or without vulvar

itching
 Burning, or irritation (which may be worse with intercourse)
 A thick, white (cottage cheese-like) vaginal discharge that clings to the
vaginal walls
 The vulva may be inflamed, with excoriation and fissures
 Symptoms increase the week before menses.
 Erythema, edema, and excoriation are common.
 pH is < 4.5 and budding yeast, pseudohyphae, or mycelia are seen on a
wet mount, especially the potassium hydroxide preparation.
 Men often are asymptomatic carriers, but may occasionally notice a
slight urethral discharge.
 They may complain of irritation and soreness of the glans penis and
prepuce, especially after intercourse
 The glans penis and prepuce may be inflamed, and white cheesy
material, vesicles, or erosions may be present.
 In severe cases, the prepuce may be edematous, causing phimosis
(constriction of the foreskin).

Treatment

 Topical or oral drugs are highly effective

 Frequent episodes of infection require long-term suppression with oral
drugs (fluconazole or ketoconazole).
 Vaginal candidiasis can be treated locally with
1. clotrimazole one 100-mg tablet/day intravaginally for 6 days or 200
mg/day for 3 days,
2. miconazole 200 mg/day intravaginally for 3 days,
3. butoconazole 2% cream 5 g/day intravaginally for 3 days,
4. terconazole one 80-mg suppository/day for 3 days or 0.4% cream 5
g/day for 7 days, or
5. econazole 1% vaginal creme or 100-mg suppositories for 3 days.
 All of these agents are used once daily at bedtime.
 Fluconazole 150 mg po once is also effective but may be more
expensive.
 Candidal balanoposthitis is treated by washing the genitalia with soap
and water, drying with a clean towel, and applying nystatin cream or
another topical agent bid for 7 to 10 days.