What are the causes of recurrent vulvovaginal candidiasis? How can recurrent episodes be diagnosed and treated effectively? Explore the details in this comprehensive article.

Prevalence and Definition of Recurrent Vulvovaginal Candidiasis

More than 50 percent of women older than 25 years have experienced at least one episode of vulvovaginal candidiasis, but fewer than 5 percent of these women experience recurrent infection. Vulvovaginal candidiasis is considered recurrent when at least four discrete episodes occur in one year or at least three episodes occur in one year and are not related to antibiotic therapy. Recurrent vulvovaginal candidiasis is distinguished from persistent infection by the presence of a symptom-free interval.

Diagnosis of Recurrent Vulvovaginal Candidiasis

Women with persistent or recurrent vulvovaginal candidiasis often present with intense vaginal discomfort, odorless vaginal discharge, pruritus, dyspareunia, or dysuria. Clinical evaluation of recurrent episodes is essential, as patients who self-diagnose risk missing other etiologies or concurrent infections. On physical examination, the patient with vulvovaginal candidiasis usually has vulvar erythema and a thick, white to yellow discharge in the vaginal vault. Potassium hydroxide (KOH) testing and fungal cultures have some limitations but are still useful for identifying the infecting species and guiding treatment. Microscopic examination of vaginal secretions in a 10 percent KOH preparation may demonstrate hyphae, and characteristic budding mycelia are seen in fewer than 30 percent of positive candidal cultures. Fungal cultures should be obtained when clinical suspicion is high and the KOH preparation is negative, or when a patient has persistent or recurrent symptoms despite treatment. In addition, a wet mount should be examined for evidence of coexisting trichomoniasis or bacterial vaginosis.

Causes of Recurrent Vulvovaginal Candidiasis

Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata. Increasingly, Candida species other than C. albicans have been found to cause yeast vaginitis, with the proportion of cases caused by non-C. albicans species increasing from 9.9 percent in 1988 to 17.2 percent in 1995. Recurrent infections may be caused by the resistance of non-C. albicans species to antifungal agents. In vitro studies have shown that imidazole antifungal agents such as miconazole and clotrimazole are not as effective against non-C. albicans fungi. C. tropicalis and C. glabrata are 10 times less sensitive to miconazole than is C. albicans.

Treatment Considerations for Recurrent Vulvovaginal Candidiasis

Imidazoles are still the first-line treatment for C. albicans infections, but a 1993 in vitro study examined more than 250 strains of C. albicans and found that no strain was resistant to ketoconazole, itraconazole, and fluconazole. However, the increasing prevalence of non-C. albicans species and their resistance to imidazole antifungals necessitates consideration of alternative treatment options.

Prophylaxis and Long-Term Management of Recurrent Vulvovaginal Candidiasis

After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.

Risk Factors and Predisposing Conditions for Recurrent Vulvovaginal Candidiasis

Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity, and hyperglycemia.

Importance of Comprehensive Evaluation and Individualized Treatment

Clinical evaluation of recurrent episodes is essential, as patients who self-diagnose may miss other causes or concurrent infections. A thorough examination, laboratory testing, and consideration of potential underlying factors are crucial for effective management of recurrent vulvovaginal candidiasis.

Treatment of Recurrent Vulvovaginal Candidiasis

ERIKA N. RINGDAHL, M.D.

Am Fam Physician. 2000;61(11):3306-3312

See related patient information handout on recurrent yeast infections, written by the author of this article.

Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.

More than 50 percent of women older than 25 years have one episode of vulvovaginal candidiasis,¹ but fewer than 5 percent of these women experience recurrent infection. ² Vulvovaginal candidiasis is considered recurrent when at least four discrete episodes occur in one year or at least three episodes occur in one year and are not related to antibiotic therapy. Recurrent vulvovaginal candidiasis is distinguished from persistent infection by the presence of a symptom-free interval.

Diagnosis

Women who have persistent or recurrent vulvovaginal candidiasis often present to their family physician with intense vaginal discomfort. Other presenting symptoms may include an odorless vaginal discharge, pruritus, dyspareunia or dysuria. Frequently, these women express their frustration with ineffective treatments.

Although the initial infection is sometimes diagnosed over the telephone, clinical evaluation of recurrent episodes is essential. Patients who self-diagnose yeast infections risk missing other etiologies or concurrent infections involving two or more organisms that require different treatments.

On physical examination, the patient with vulvovaginal candidiasis usually has vulvar erythema and a thick, white to yellow discharge in the vaginal vault.

Potassium hydroxide (KOH) testing and fungal cultures have some limitations, but they are still useful for identifying the infecting species and guiding treatment. Microscopic examination of vaginal secretions in a 10 percent KOH preparation may demonstrate hyphae. Characteristic budding mycelia are seen in fewer than 30 percent of positive candidal cultures.³ Fungal cultures should be obtained when clinical suspicion is high and the KOH preparation is negative, or when a patient has persistent or recurrent symptoms despite treatment. In addition, a wet mount should be examined for evidence of coexisting trichomoniasis or bacterial vaginosis.

Causes of Recurrence

Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata. Increasingly, Candida species other than C. albicans have been found to cause yeast vaginitis (i. e., 9.9 percent of cases in 1988 and 17.2 percent of cases in 1995).⁴ In fact, recurrent infections may be caused by the resistance of non– C. albicans species to antifungal agents.

In vitro studies have shown that imidazole antifungal agents such as miconazole and clotrimazole are not as effective against non– C. albicans fungi. C. tropicalis and C. glabrata are 10 times less sensitive to miconazole than is C. albicans.⁵ Imidazoles are still the first-line treatment for C. albicans infections. A 1993 in vitro study examined more than 250 strains of C. albicans and found that no strain was resistant to ketoconazole, itraconazole and clotrimazole.⁶

Although antifungal resistance can cause treatment failure, other factors may contribute to recurrent vulvovaginal candidiasis (Table 1).^5,7–15 Noncompliance with a treatment regimen may result in persistent infection that is mislabeled as a recurrence. For example, a patient may not complete the entire course of antifungal therapy, especially if an inconvenient topical treatment has been prescribed. A recurrence may also represent an inadequately treated infection. Between 15 and 20 percent of women with negative cultures after treatment have positive cultures within three months.¹⁶ If an infection recurs at least three months after the previous episode, it is more likely to be caused by a different C. albicans strain.⁷TABLE 1

Possible Risk Factors for Recurrent Vulvovaginal Candidiasis

Information from references ⁵ and ⁷ through ¹⁵.

Antibiotics are often implicated as a cause of recurrent vulvovaginal candidiasis. Frequent antibiotic use decreases protective vaginal flora and allows colonization by Candida species.⁸ The risk of a yeast infection increases with the duration of antibiotic use, but no specific antibiotic has been shown to be more likely to cause yeast infections.⁹

Diabetes mellitus is often considered a predisposing factor for recurrent vulvovaginal candidiasis. Hyperglycemia enhances the ability of C. albicans to bind to vaginal epithelial cells.¹⁰ However, unless other symptoms are suggestive of diabetes, patients with recurrent vulvovaginal candidiasis are rarely found to be diabetic.⁸

Contraceptive methods may also promote recurrences of vulvovaginal candidiasis. Use of spermicidal jellies and creams increases susceptibility to infection by altering the vaginal flora and increasing the adhesion of Candida organisms. Women who take oral contraceptive pills have a higher rate of vulvovaginal candidiasis. ¹¹ According to one theory, Candida cells have estrogen and progesterone receptors that, when stimulated, increase fungal proliferation.⁸

Women who are prone to recurrent vulvovaginal candidiasis may have deficient cell-mediated immunity. Similarly, persons with acquired immunodeficiency syndrome are susceptible to systemic candidal infection. Some studies suggest that 40 to 70 percent of women with recurrent vulvovaginal candidiasis have some specific anergy resulting in a subnormal T-lymphocyte response to Candida.¹² One study found that Lewis A and B blood group antigens on the vaginal epithelium are protective against candidal infection.¹³

Mechanical factors may also be important. Perspiration associated with tightly fitted clothes or poorly ventilated underwear increases local temperature and moisture. Mechanical irritation of the vulvovaginal area by clothing or with sexual intercourse may also predispose already colonized areas to infection. One study demonstrated a positive relationship between the monthly frequency of sexual intercourse and the incidence of recurrent vulvovaginal candidiasis.¹⁴

Dietary habits have been suggested as causes of recurrent vulvovaginal candidiasis. However, most studies do not support a role for dietary factors in the etiology of recurrences, and adherence to strict diets has not been beneficial.⁸

The role of sexual transmission is controversial. One study found identical Candida strains in the sexual partners of 48 percent of women with recurrent infections.⁷ A randomized, controlled trial evaluated the effect that treating male sexual partners with oral ketoconazole had on the recurrence rates for vulvovaginal candidiasis.¹⁵ The recurrence rates in the treated and untreated partner groups were found to be similar at six months and one year. Topical antifungal therapy has been ineffective in male sexual partners, probably because of the presence of reservoirs not reached by this treatment. In summary, no clinical trial has found that the treatment of male sexual partners prevents recurrences of vulvovaginal candidiasis in women.

Some investigators have advocated the elimination of Candida from the gastrointestinal tract. The rationale is that reinfection from an intestinal reservoir contributes to vaginal recurrences. However, studies have not found an association between recurrent vulvovaginal candidiasis and the presence of intestinal Candida.¹⁶

Treatment

The optimal treatment for recurrent vulvovaginal candidiasis has not yet been defined (Table 2). Consequently, treatment must be individualized based on a comparison of effectiveness, convenience, potential side effects and cost.

If a patient has infrequent recurrences, the simplest and most cost-effective regimen involves self-diagnosis and the early initiation of topical therapy. A prospective randomized, open, crossover study in 23 women with proven recurrent vulvovaginal candidiasis examined the efficacy and cost benefit of monthly prophylaxis compared with empiric self-treatment at the onset of symptoms. ¹⁷ Patients were randomized to receive one 500-mg dose of clotrimazole intravaginally each month with the menses for six months or one 500-mg dose of clotrimazole intravaginally at the onset of symptoms. After six months, patients were switched (crossover) to the other regimen.

In this study,¹⁷ 50 episodes of symptomatic vaginitis (2.2 episodes per patient) occurred with the prophylactic regimen, and 86 episodes (3.7 episodes per patient) occurred with empiric treatment. During the prophylactic period, the women used an average of 7.3 doses of clotrimazole, compared with 3.6 doses during the empiric treatment period. When asked about their personal preference, almost 75 percent of the women preferred the empiric regimen. The authors of the study concluded that although prophylactic perimenstrual clotrimazole therapy may reduce the number of symptomatic episodes, empiric self-treatment is more cost-effective and acceptable to patients. Problems with the empiric regimen include inappropriate use and a delay in diagnosis if the patient does not have vaginal candidiasis. In addition, the 500-mg troche of clotrimazole is no longer available.

If a woman with an established diagnosis of recurrent vulvovaginal candidiasis does not respond to an imidazole, infection with a resistant non– C. albicans species may be present. Terconazole vaginal cream (Terazol) is the agent of choice when infection with a species other than C. albicans is suspected. The potent interference of this agent with the cytochrome P450 isoenzymes makes C. tropicalis and C. glabrata more susceptible to treatment.

After the acute episode of recurrent vulvovaginal candidiasis has been treated, subsequent prophylaxis or maintenance therapy is essential. In one clinical trial, women with a history of recurrent vulvovaginal candidiasis were randomized to receive 400 mg of ketoconazole for 14 days or clotrimazole in the form of 100-mg vaginal suppositories for seven days.¹⁸ One week after treatment, the clinical cure rate was higher than 80 percent in both groups. Two months after treatment, in the absence of any maintenance therapy, 53 percent of women in the ketoconazole treatment group and 63 percent of those in the clotrimazole treatment group had recurrences.

Several maintenance regimens have been studied. In one clinical trial, 74 women with recurrent vulvovaginal candidiasis were treated for an acute episode with 400 mg of ketoconazole per day for 14 days.¹⁹ The women were then randomized to receive one of three treatments: placebo, 400 mg of ketoconazole administered orally for five days after the menses for six months, or 100 mg of ketoconazole administered orally each day for six months. The six-month recurrence rates were 71 percent for the placebo group, 29 percent for the cyclic-regimen group and 5 percent for the daily-regimen group.

Maintenance therapy needs to be given frequently enough to prevent vaginal regrowth, but the optimal dosing interval is not clear. One study suggested that the weekly administration of 0. 8 percent terconazole vaginal cream is nearly as effective as daily treatment with ketoconazole.²⁰ Similar efficacy has been noted for twice-weekly intravaginal treatment with 200 mg of clotrimazole.²¹

A monthly 150-mg dose of orally administered fluconazole has been shown to reduce the incidence of recurrences by 50 percent.²² Itraconazole, in a dosage of 200 mg²³ or 400 mg²⁴ administered orally once a month, also has been found to decrease the recurrence rate by approximately 50 percent. Boric acid, administered in a 600-mg vaginal suppository twice daily for two weeks and then daily during menstruation, has been effective in the treatment of women with resistant infection.³ However, the use of boric acid is limited by significant local irritation and the possibility of intoxication.²⁵

Based on the study findings, ketoconazole (Nizoral) administered orally once a day, clotrimazole (Gyne-Lotrimin) administered intravaginally twice weekly, terconazole administered intravaginally once a week, and fluconazole (Diflucan) or itraconazole (Sporanox) administered orally once a month have been relatively effective in reducing the recurrence rate for vulvovaginal candidiasis.

Most studies recommend prophylaxis for six months. Then the woman is reevaluated. Many women have recurrences once prophylaxis is discontinued. Thus, they may need to stay on medication for a longer period.

The expense of each regimen should be considered. The costs given in Table 2 do not include the expenses associated with decreased work productivity, missed work days, toxicity monitoring or office visits. TABLE 2

Treatment Options for Recurrent Vulvovaginal Candidiasis

Agent	Dosing regimen	Cost for brand name (generic) regimen*
Treatment of acute episode
Clotrimazole (Gyne-Lotrimin)	100-mg tablets administered intravaginally for seven days	$ 16
Terconazole 0.8 percent cream (Terazol 3)	One full applicator (5 g) administered intravaginally for three days†	29
Fluconazole (Diflucan)	150 mg administered orally (one dose)	12
Ketoconazole (Nizoral)	200 mg administered orally once daily for 14 days	47 (42)
	400 mg administered orally once daily for 14 days	94 (84)
Boric acid	600-mg vaginal suppository administered twice daily for 14 days	NA‡
Prophylaxis (maintenance)
Clotrimazole (Gyne-Lotrimin)	Two 100-mg tablets administered intravaginally twice weekly for six months	32 §
Ketoconazole (Nizoral)	Two 200-mg tablets administered orally for five days after the menses for six months	33 (30)§
	One half of a 200-mg tablet administered orally once daily for six months	51 (46)§
Terconazole 0. 8 percent cream (Terazol 3)	One full applicator (5 g) administered vaginally once a week†	29§
Fluconazole (Diflucan)	150 mg administered orally once a month	12§
Itraconazole (Sporanox)	One 200-mg tablet administered orally once a month	7§
	Two 200-mg tablets administered orally once a month	14§
Boric acid	600-mg vaginal suppository administered once daily during menstruation (5-day menses)	NA‡

NA = not available commercially.

*—Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar) in Red book. Montvale, N.J.: Medical Economics Data, 1999. Cost to the patient will be greater, depending on prescription filling fee.

†—Dosages based on the literature, not on indications given in Physicians’ Desk Reference. 53d ed. Montvale, N.J.: Medical Economics, 1999.

‡—Although boric acid suppositories are not commerically available, they can be compounded; based on figures from the University of Missouri, the cost for compounding one suppository ranges from $0.75 to $1.00.

§—Monthly cost.

A 1992 crossover study assessed the association between the daily ingestion of yogurt containing Lactobacillus acidophilus and the prevention of recurrent vulvovaginal candidiasis.²⁶ Women were assigned to a yogurt-free diet or a yogurt-containing diet. Although only 13 of 21 women completed the protocol, the women who ingested yogurt had a threefold reduction in infection. The authors of the study concluded that daily ingestion of 8 oz of yogurt containing L. acidophilus decreased the rate of candidal infection. A second study showed no difference in infection rates between women who ingested pasteurized yogurt and women who ingested yogurt that contained L. acidophilus.²⁷ Additional evidence is needed before management recommendations can be made.

In addition to cost, other factors may determine the most appropriate regimen. Compliance rates are greater for medications that are taken orally rather than intravaginally. However, the potential for systemic toxicity and drug interactions is greater with orally administered medications.

Gastrointestinal side effects occur in 15 percent of patients treated with orally administered antifungal agents.²⁸ In addition, hepatic toxicity has been noted in one of 15,000 persons treated with orally administered ketoconazole.²⁹ Although clotrimazole therapy may cause local discomfort, it is less frequently associated with systemic toxicity (headache occurs in 9 percent of recipients and abdominal pain is a problem in 3 percent of recipients).³⁰

Compared with ketoconazole, fluconazole is less likely to be toxic. Because fluconazole is administered orally, treatment compliance is better than with clotrimazole, which is administered intravaginally. Patients treated with fluconazole report headache (12 percent), abdominal pain (7 percent) and nausea (4 percent).³⁰

Many antifungal agents have significant interactions with other medications. For example, interactions have been noted between fluconazole and warfarin (Coumadin), oral hypoglycemic agents, phenytoin (Dilantin), theophylline and rifampin (Rifadin).³¹ Other drugs reported to interact with fluconazole include cyclosporine (Sandimmune), zidovudine (Retrovir) and hydrochlorothiazide (Esidrix).

Causes, Symptoms and Treatment Options

Medically reviewed by Drugs.com. Last updated on Jun 1, 2023.

What is Candidiasis?

Candidiasis is an infection caused by Candida fungi, most of by Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant “native” species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina.   

Usually, Candida is kept under control by the native bacteria and by the body’s immune defenses. If the mix of native bacteria is changed by antibiotics or the body moisture that surrounds native bacteria undergoes changes in its acidity or chemistry, it can allow yeast to thrive and cause symptoms.  

Candidiasis can affect many parts of the body, causing localized infections or larger illness, depending on the person and his or her general health. 

Candida infections can cause symptoms in healthy people. Usually the yeast infections are limited to the mouth, genital area or skin. However, people with a weakened system from illness or medications such as corticosteroids or anticancer drugs are not only more susceptible to topical infections, they also are more likely to experience a more serious internal infection.

Places on and in the body that may be affected by candidiasis include: 

• Thrush — Thrush is the common name for a mouth infection caused by the Candida albicans fungus. It affects moist surfaces around the lips, inside the cheeks, and on the tongue and palate.  
• Esophagitis — Candida infections of the mouth can spread to the esophagus, causing esophagitis.  
• Cutaneous (skin) candidiasis — Candida can cause skin infections, including diaper rash, in areas of skin that receive little ventilation and are unusually moist. Some common sites include the diaper area; the hands of people who routinely wear rubber gloves; the rim of skin at the base of the fingernail, especially for hands that are exposed to moisture; areas around the groin and in the crease of the buttocks; and the skin folds under large breasts. 
• Vaginal yeast infections — Vaginal yeast infections are not usually transmitted sexually. During a lifetime, 75% of all women are likely to have at least one vaginal Candida infection, and up to 45% have 2 or more. Women may be more susceptible to vaginal yeast infections if they are pregnant or have diabetes. The use of antibiotics or birth control pills can promote yeast infections. So can frequent douching. 
• Deep candidiasis (for example, candida sepsis) — In deep candidiasis, Candida fungi contaminate the bloodstream and spread throughout the body, causing severe infection. This is especially common in newborns with very low birth weights and in people with severely weakened immune systems from illness or medications such as anticancer drugs. In these people, Candida fungi may get into the bloodstream through skin catheters, tracheostomy sites, ventilation tubing, or surgical wounds. Deep candidiasis also can occur in healthy people if Candida fungi enter the blood through intravenous drug abuse, severe burns or wounds caused by trauma.

Symptoms

Candidiasis causes different symptoms, depending on the site of infection. 

• Thrush — Thrush causes curd-like white patches inside the mouth, especially on the tongue and palate and around the lips. If you try to scrape off this whitish surface, you will usually find a red, inflamed area, which may bleed slightly. There may be cracked, red, moist areas of skin at the corners of the mouth. Sometimes thrush patches are painful, but often they are not.  
• Esophagitis — Candida esophagitis may make swallowing difficult or painful, and it may cause chest pain behind the breastbone (sternum).  
• Cutaneous candidiasis — Cutaneous candidiasis causes patches of red, moist, weepy skin, sometimes with small pustules nearby.

• Vaginal yeast infections — Vaginal yeast infections may cause the following symptoms: vaginal itch and/or soreness; a thick vaginal discharge with a texture like soft or cottage cheese; a burning discomfort around the vaginal opening, especially if urine touches the area; and pain or discomfort during sexual intercourse.

• Deep candidiasis — When Candida spreads to the bloodstream, it may cause a wide range of symptoms, from unexplained fever to shock and multiple organ failure.

Diagnosis

Your doctor will want details about your medical history. He or she also will ask about your diet and about your recent use of antibiotics or medications that can suppress the immune system. If your doctor suspects cutaneous candidiasis, he or she may ask how you care for your skin and about conditions that expose your skin to excessive moisture.  

Often, your doctor can diagnose thrush, cutaneous candidiasis, or vaginal yeast infection by a simple physical examination. However, if the diagnosis is uncertain, your doctor may obtain a sample by gently scraping the involved surface to examine under a microscope or may send it for culture. A culture is especially helpful if you have a yeast infection that returns after treatment. In this case, the culture can help identify whether the yeast is resistant to usual antifungal therapy. If your doctor suspects that you have an undiagnosed medical illness that increases your risk of candidiasis — such as diabetes, cancer or HIV — blood tests or other procedures may be necessary. 

To diagnose Candida esophagitis, your doctor may to need to refer you to a specialist who can examine your esophagus with an endoscope, a flexible instrument that is inserted into your throat and allows the doctor to look at the area directly. During this examination, called endoscopy, the doctor will take a sample of tissue (either a biopsy or a “brushing”) from your esophagus to be examined in a laboratory. 

To diagnose deep candidiasis, your doctor will draw a sample of blood to be checked in a laboratory for the growth of Candida fungi or other infectious agents. 

Expected Duration

In otherwise healthy people who have thrush, cutaneous candidiasis, or vaginal yeast infections, Candida infections usually can be eliminated with a short treatment (sometimes a single dose) of antifungal medication. However, in people with AIDS or other diseases that weaken the immune system, Candida infections can be difficult to treat and can return after treatment. In people with weakened immune systems, candidiasis can be life threatening if it passes into the blood and spreads to vital organs. 

Prevention

In general, you can prevent most Candida infections by keeping your skin clean and dry, by using antibiotics only as your doctor directs, and by following a healthy lifestyle, including proper nutrition. People with diabetes should try to keep their blood sugar under tight control. 

Treatment

Treatment of candidiasis varies, depending on the area affected: 

• Thrush — Doctors treat thrush with topical, antifungal medications such as nystatin (Mycostatin and others) and clotrimazole. For mild cases, a liquid version of nystatin can be swished in the mouth and swallowed, or a clotrimazole lozenge can be dissolved in the mouth. For more severe cases, an antifungal drug such as fluconazole (Diflucan) can be taken once a day by mouth.   
• Esophagitis — Candida esophagitis is treated with an oral antifungal drug such as fluconazole. 
• Cutaneous candidiasis — This skin infection can be effectively treated with a variety of antifungal powders and creams. The affected area must be kept clean and dry and protected from chafing.  
• Vaginal yeast infections — Vaginal yeast infections can be treated with antifungal medications that are applied directly into the vagina as tablets, creams, ointments or suppositories. These include butoconazole (Femstat), clotrimazole (Gyne-Lotrimin), miconazole (Monistat, Vagistat and others), nystatin (Mycostatin and others), and tioconazole (Monistat-1, Vagistat-1). A single dose of oral fluconazole can be used. Sex partners usually do not need to be treated. 
• Deep candidiasis — This infection usually starts with an intravenous anti-fungal drug, such as voriconazole or fluconazole. People with very low white blood cell counts may need an alternative intravenous antifungal drug, such as caspofungin or micafungin.  

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

• nystatin
• Nystop
• Lamisil
• Nyamyc
• clotrimazole

View more treatment options

When To Call a Professional

Call your doctor whenever you have symptoms of candidiasis. 

Women that are otherwise healthy can self-treat for simple candida vaginitis. Call your doctor if it persists despite topical therapy or it recurs soon after treatment.

Prognosis

Typically, in otherwise healthy people with superficial candidiasis, a properly treated infection goes away without leaving permanent damage. Superficial candidiasis may take longer to treat and is more likely to recur in people that need long courses of antibiotics. 

In people with chronic illnesses or weakened immune systems, episodes of candidiasis may be more resistant to treatment and may return after treatment ends. In people with deep candidiasis, those who are diagnosed quickly and treated effectively have the best prognosis, especially if their infection can be stopped before it spreads to major organs. 

Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov/

Learn more about Candidiasis

Treatment options

• Medications for Cutaneous Candidiasis

Care guides

• Cutaneous Candidiasis Care Notes

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Treatment of chronic candidiasis in women in Novorossiysk, prices

Chronic candidiasis (thrush) is a fungal disease caused by the active development of yeast-like fungi of the genus Candida in the female reproductive system. These microorganisms belong to the conditionally pathogenic microflora, and are present in every woman. Thrush develops precisely with their significant reproduction under the influence of various adverse factors.

At first, the disease manifests itself in an acute form. It affects the mucous membranes of the cervix, vulva, vagina. If the disease is not treated in time, a chronic form may develop. At the same time, acute periods usually alternate with a “lull” without visible manifestations, which greatly complicates the diagnosis. To avoid serious complications, it is important to identify the disease in time and start treatment.

Features of this disease

Candidiasis is considered chronic if more than 3 exacerbations of the disease occur per year. This form of pathology is observed in approximately 5-25% of cases. Often it is associated with inattention to health, when a woman does not go to the doctor, even despite the unpleasant signs of vaginal candidiasis, or ignores the appointment of a gynecologist.

During chronic thrush, periods of exacerbation and calm alternate. Therefore, symptoms may come and go. Pathology is often complicated by other concomitant diseases: herpes, sexually transmitted diseases, etc. They can change the symptoms of chronic candidiasis, which greatly complicates the diagnosis.

Thrush is especially dangerous during pregnancy, as it harms both the woman and the fetus. An examination for candidiasis should be completed even before conception is planned, and it is advisable to do this for both partners.

Main causes

Suitable provocative factors are needed for active reproduction of Candida fungi:

• hormonal changes;
• inflammatory processes in the pelvic area;
• prolonged use of antibacterial drugs, hormonal contraceptives and eubiotics;
• malnutrition that causes dysbacteriosis and/or high blood sugar;
• bacterial vaginosis;
• sexual contact with a carrier of the disease without barrier contraceptives;
• non-compliance with the rules of personal hygiene;
• problems with the endocrine system;
• Strongly weakened immunity due to other diseases, beriberi, unfavorable living conditions.

Before starting therapy, it is especially important to identify the cause of chronic vaginal candidiasis in order to eliminate this factor. Otherwise, if it is repeated, it will not be possible to defeat the disease.

Danger of chronic candidiasis

Complications of chronic vaginal candidiasis pose the greatest danger to a woman’s health:

• adhesions in the pelvic area;
• worsening of the functions of the genitourinary system;
• lesions of the large intestine and uterine appendages;
• infertility;
• miscarriages due to serious intrauterine infection.

There is also a weakening of the immune system, which causes infectious diseases and inflammatory processes in other systems and organs.

During the treatment of vaginal candidiasis, drugs with lactobacilli should not be taken. Otherwise, they can cause complications of the disease, and the fungus will begin to grow more actively. Means with lactobacilli can only be used during the recovery period after the treatment of chronic thrush to normalize the microflora.

Symptoms of chronic candidiasis

Not always chronic vaginal candidiasis has obvious symptoms. It can take place in an implicit form. The problem can be recognized by the following signs:

• redness and slight swelling in the groin;
• dryness of mucous membranes with loss of gloss;
• discomfort in the genital area that gets worse during sex;
• whitish discharge after intercourse with a sharp sour smell;
• exfoliating and brittle nails.

In chronic thrush, there may be little or no vaginal discharge. You can recognize them by a sharp unpleasant odor and scanty white cheesy mucus on the linen. With a long course of the chronic form of vaginal candidiasis, a foam may appear that is poorly separated.

Often the discharge appears only during an exacerbation. They may be accompanied by severe itching and / or burning in the genital area. Such symptoms appear due to irritation of the mucous membranes by fungi and their metabolic products. Itching in the chronic form of thrush is tolerable and passes quickly.

Vaginal candidiasis is rarely painful. Such symptoms can appear only in the acute period during urination, when the urethra becomes inflamed.

Treatment of chronic vaginal candidiasis is a lengthy process, so women are advised to make an appointment with a doctor as soon as they suspect an illness, such as itching or burning in the vaginal area, pain when urinating, discomfort after or during sex.

Diagnosis

Most often, women turn to a gynecologist during an exacerbation of the disease with a complaint of such symptoms of chronic candidiasis as unusual cheesy vaginal discharge and itching.

The chronic form of thrush is difficult to detect in a regular smear, so blood is also taken to study its manifestations. Additionally, it is worth taking tests for hormones and sexual infections, since chronic candidiasis often develops against the background of hormonal failure or other diseases.

An accurate diagnosis can only be made after a comprehensive and detailed examination in the clinic. The sooner the disease is detected, the easier and faster the treatment.

Only by strictly following the doctor’s recommendations, you can get rid of chronic thrush and its unpleasant symptoms.

Carrying out therapy

Getting rid of chronic vaginal candidiasis is quite difficult, as relapses of the disease are often noted. Its appearance is associated with disorders in the immune system of a woman as a whole. Therefore, the treatment of the disease is possible only by complex measures, which are aimed at:

• exclusion of the cause of the pathology;
• improvement of immune status and hormonal levels;
• prevention of recurrence of candidiasis.

In addition to drugs for chronic thrush, it is important to take medicines that are aimed at restoring normal microflora and strengthening immunity.

It is worth being treated together with your sexual partner, as he could become infected. Therefore, you should not be silent about your disease, otherwise you risk getting candidiasis again.

Therapy may vary. In order for the treatment of candidiasis to be effective, it is important to strictly follow the recommendations of the gynecologist. Preparations are selected taking into account the sensitivity of the fungus to drugs. One of the traditional methods of treating chronic candidiasis in women:

1. Application of suppositories and other local vaginal agents 1-2 times a week.
2. Taking oral antifungals.
3. Compliance with hygiene rules.

Topical drugs are considered a priority in the treatment of thrush, since most of them do not have a toxic effect on the liver and kidneys. However, suppositories against vaginal candidiasis are undesirable to use during pregnancy or lactation, as they have components that adversely affect the bearing of a child. These local agents are usually replaced with ointments. You should not increase the dosage of drugs without consulting a doctor, since antimycotic drugs are very toxic.

In some cases, there are forms of vaginosis, which are caused simultaneously by fungal and bacterial microorganisms. Then the gynecologist prescribes a joint intake of antibacterial and antifungal drugs.

Therapy lasts several weeks (the exact timing depends on the severity of the disease, on average 3 months). At this time, it is not recommended to use tampons in order to avoid microdamages of the mucosa and not to spread the infection further. After the main course, it is desirable to conduct a control examination, as well as the prevention of relapses.

During treatment, it is worth abstaining from sexual intercourse for up to 20-30 days after recovery, as the immune system is just beginning to recover. Otherwise, there is a risk of infection from a partner whose fungal infection has not been completely cured.

For the duration of therapy, it is worth refusing or significantly limiting the consumption of sweet and yeasty pastries. The menu should be dominated by non-spicy and low-fat foods. It is advisable to focus on unsweetened vegetables and meat.

The doctor may recommend a change in the mode of work and rest, cure concomitant diseases, increase the duration of sleep, quit smoking and alcohol.

How to prevent chronic thrush?

For the prevention of candidiasis, it is important to take care of strengthening the immune system and a healthy lifestyle in general:

• avoid promiscuous sexual intercourse without methods of barrier contraception;
• regularly follow the rules of personal hygiene;
• use only dermatologically approved personal care products;
• limit the use of antibacterial hygiene products;
• do not take antibacterial and hormonal drugs without a doctor’s prescription;
• periodically carry out vitamin therapy.

Regular walks in the fresh air and dosed physical activity will also help. They strengthen the immune system, and the body copes better with negative influences.

Traditional treatments for chronic vaginal candidiasis

Traditional medicine recipes are suitable as an auxiliary treatment for chronic candidiasis. The tactic is to create a healthy environment that is detrimental to pathogenic fungi. This can be achieved through the following means:

• oregano oil – used only in diluted form (otherwise you can get a chemical burn). It is necessary to pour 3 tablespoons of vegetable oil into a small vessel and add a few drops of oregano. The mixture is applied to the affected areas of the body with a medical pear. First, it is better to try on healthy skin, if inflammatory reactions appear, the solution should be washed off immediately, and the dosage of oregano should be reduced to 1 drop;
• tar soap – used for daily washing before going to bed;
• mixture of iodine and soda – the solution consists of 1 liter of water, a tablespoon of soda and a teaspoon of iodine. This product needs to be washed regularly. A new solution is prepared before each individual use.

During the recovery period, herbal decoctions and infusions will help to consolidate the successful result of therapy and prevent the recurrence of the disease:

• chamomile flowers – take 50 g of dried chamomile flowers for half a liter of water. The mixture must be heated over low heat for 20 minutes, then strain and use for washing;
• marigold, sage and yarrow mixture – you will need three tablespoons of each herb. The collection should be poured with 0.5 liters of boiling water, left in a dark place to cool, then strain. The infusion is useful for irrigating the affected areas of the genital organs with the help of a medical pear.

Such folk recipes for getting rid of chronic candidiasis should be used only after eliminating allergies.

Cost of chronic candidiasis treatment

Our multidisciplinary clinic in Novorossiysk offers services for the treatment of chronic candidiasis. We help women at any stage of the disease. The treatment regimen is selected individually.

You can see the cost of individual procedures on the website or check with a consultant. The final price of treatment depends on the prescribed therapy and is calculated after the examination, taking into account the characteristics of the disease, symptoms and comorbidities.

Other articles:

Treatment of candidiasis in women

Go to the full list of paid services in gynecology

Author of materials

Obstetrician-gynecologist of the first category

Alexey Bychkov

What is candidiasis and how is it treated

December 10, 2022

Likbez

Health

It’s not just thrush in women.

What is candidiasis

Candidiasis is a fungal infection caused by overgrowth of yeast-like fungi Candida, more often than albicans . These microorganisms normally live in humans on the skin, in the vagina and in the mouth in small quantities. Normally, the beneficial part of the microbiota inhibits the growth of Candida, but if the balance is disturbed, an infection develops.

In whom candidiasis is more common

The balance of microorganisms is usually disturbed by provoking factors. These include:

• taking antibiotics and other medicines that inhibit the growth of beneficial bacteria;
• treatment with steroids and other immunosuppressive drugs;
• uncontrolled diabetes;
• human immunodeficiency virus infection;
• cancer and its treatment;
• other diseases that suppress the immune system;
• development of the immune system in newborns;
• taking medicines that have dry mouth as a side effect, such as antihistamines;
• hormonal disorders, eg pregnancy;
• taking combined oral contraceptives, which also interfere with hormonal balance;
• stress;
• a diet high in refined carbohydrates (white flour, processed cereals), sugar and yeast.

Due to the action of triggers, yeast becomes too much, so symptoms of infection will appear. Signs will vary depending on the place where there are a lot of mushrooms.

What is candidiasis

Since candida live in different parts of the body, they cause different diseases.

Urogenital candidiasis

This type of fungal infection is the most common. It is believed that 70-75% of women at least once in their lives experience vaginal candidiasis, which in everyday life is called thrush. The infection affects the vulva, or external genitalia, and the vagina. This is manifested by the following symptoms:0003

• copious thick white vaginal discharge, like curdled milk or cottage cheese;
• copious watery discharge;
• itching and burning, especially during sex and when urinating;
• redness and swelling of the vulva, sometimes rash.

In men, rashes appear less frequently and affect the head of the penis and the foreskin. Because of this, the following symptoms may appear:

• irritation, burning and redness around the glans penis and under the foreskin;
• white curdled discharge from the urethra;
• bad smell of penis;
• difficulty in retracting the foreskin.

Oral candidiasis

It is also sometimes called thrush. Oral candidiasis usually occurs in newborns, because their immune system encounters microorganisms for the first time and cannot yet fully protect itself from the disease, and in immunocompromised people. Then white spots or plaque appear in the mouth. If you remove it, then under it there may be sores. These foci hurt and interfere with eating.

Candidiasis of the skin

It usually occurs in folds or on rubbing surfaces: in the interdigital spaces, in the axillary, anal, inguinal folds, under the breasts or under the abdomen in obese people, under diapers in infants. There are rashes and rashes. Usually, in addition to a decrease in immunity, hot weather, poor hygiene, and tight clothing are to blame.

Candida also affects the nails and the skin around them. This happens after manicure injuries or often happens to kitchen workers who are in contact with water for a long time.

Intestinal candidiasis

Candida may be a normal part of the microbiota. But if immunity suffers or there are already some inflammatory diseases in the intestines, then there are more yeasts and they can aggravate existing ulcers or provoke the appearance of new ones. Symptoms will be similar to other bowel diseases. For example, there are pain, diarrhea, constipation and others.

Candidal granuloma

Granuloma is the name of a dense focus of chronic inflammation on the skin or mucous membranes. Candidal granuloma is an extremely rare disease that occurs due to chronic candidiasis, and it is quite difficult to cure it.

Candidiasis of the respiratory tract

Very rarely, the infection can enter the respiratory tract. Then bronchopulmonary candidiasis develops. Its symptoms resemble other diseases of the respiratory system. There are coughs, fever, chest pain, and the like.

Systemic candidiasis

This is a very serious infection that occurs in people who are severely immunocompromised, such as during chemotherapy. It usually develops in a hospital when a person has a venous catheter or receives frequent intravenous injections. Then the fungi from the skin enter the bloodstream and spread through the internal organs, such as the brain, heart, bones, and others. In this case, up to a quarter of all patients die.

How candidiasis is treated

Candidiasis is usually treated quite simply. Since this is a fungus, antifungal drugs are needed, for example, based on fluconazole. They can be local (in the form of creams, suppositories and solutions) or in tablets. Most often, the treatment does not last long, and relief comes in just a few days.

If candidiasis is systemic, then more serious drugs are needed, which are injected directly into the vein, and treatment can last several weeks or months.