What does a yeast infection look like? Examples and treatments

The appearance of a yeast infection, or candidiasis, depends on its location. It can cause white patches in the mouth, flaking or crusting of the skin, and changes in genital discharge, which may look like cottage cheese.

In this article, we describe how a yeast infection visibly affects the body. We also look at other symptoms, treatments, and more.

A yeast infection occurs when fungi grow excessively in the body. This is particularly common in moist areas with less exposure, such as the mouth, vagina, or feet.

Often, yeast infections are caused by fungi from the Candida species — and according to the Centers for Disease Control and Prevention (CDC), Candida albicans is the type most likely to overgrow and cause an infection.

A vaginal yeast infection, or thrush, typically causes white discharge that is the texture of cottage cheese.

Other symptoms of a vaginal yeast infection include:

• painful urination
• soreness around the vagina
• inflammation and itchiness of the vagina and vulva
• pain during sex

These infections are common, with up to 75% of females having at least one diagnosed in their lifetimes.

Yeast infections can affect the penis, but this is less common. The symptoms tend to develop on the underside of the penis and include:

• scaling
• inflamed patches of skin
• a painful rash

A yeast infection can also cause inflammation near the head of the penis. This issue is called balanitis.

A person with balanitis may experience burning or itching and yellow or white discharge. In some people, the inflammation spreads to the shaft and the area under the foreskin.

Yeast infections are not considered sexually transmitted infections (STIs). However, it is possible for a person to develop a yeast infection after having oral, anal, or vaginal sex with someone who has the condition, especially if they are especially susceptible.

Around 15% of males who have unprotected sex with females experiencing yeast infections develop the infection themselves.

Oral thrush occurs when yeast grows excessively in the mouth or throat. Typically, a person develops white patches on the tongue, cheeks, back of the throat, or roof of the mouth.

Other symptoms of oral thrush include:

• soreness
• pain while eating or drinking
• a cotton-like feeling in the mouth
• cracked skin at the corners of the mouth
• a loss of taste

Most healthy adults do not develop oral thrush, but yeast infections in the mouth or esophagus are common in people with weakened immune systems.

Wearing dentures, smoking, and having dry mouth also elevate the risk of developing oral thrush.

The appearance of a yeast infection on the skin depends on the location, but this type of infection often causes patches of inflammation. These can vary in shape and size.

Sometimes, these patches itch, flake, or develop crusts, and pustules may appear around the edges.

A yeast infection can occur anywhere on the skin, but is most likely to develop in folds, such as:

• under the breasts
• under the arms
• in the groin
• under or in the buttocks
• in the navel
• on the scalp
• between the fingers and toes

If a yeast infection occurs on the scalp, it can cause crusty lesions that can lead to hair loss. Yeast infections can also cause diaper rash in babies.

Yeast infections can develop beneath the nails. An infected nail may turn white or yellow and start to separate from the nail bed.

When a yeast infection occurs under the nails, a person may experience:

• painful swelling
• pus
• nail loss

In small amounts, Candida fungi are not harmful. Many people have yeast on their skin and in their body. Other types of microbe, such as bacteria, help keep Candida from growing excessively.

However, certain factors can disrupt the body’s ability to keep Candida under control, such as:

• Antibiotics: Because antibiotics kill bacteria, the result may be that Candida fungi grow unchecked.
• Hormonal contraceptives: People who take hormonal birth control that contains estrogen are more likely to develop yeast infections.
• Pregnancy: Similarly, the hormonal changes during pregnancy increase the chances of developing yeast infections.
• A weak immune system: Young babies and people with immune disorders or conditions such as HIV may be more susceptible to yeast infections.
• Medications: Some medications and treatments, including steroids, immunosuppressants, and chemotherapy also weaken the immune system.
• Diabetes: Sugar helps yeast grow, so if a person frequently has high blood sugar levels, they are more likely to develop candidiasis.

Vaginal douches and sprays may also increase the risk of developing a vaginal yeast infection.

The treatment for a yeast infection varies, depending on the infection’s location and severity.

For mild, occasional infections, a person can try over-the-counter options, such as topical creams, nail treatments, or vaginal suppositories.

However, it is important to speak with a pharmacist or doctor first, because the symptoms of a vaginal yeast infection are similar to those of bacterial vaginosis and some STIs.

These issues do not respond to yeast infection treatments. They require different approaches and can cause serious health complications if a person does not receive the necessary care.

Also, frequently using antifungal medicine unnecessarily may reduce how effective it is in the future.

For more severe or reoccurring infections, a person may need prescription antifungal medication.

Pregnant women should not take the antifungal medicine fluconazole (Diflucan), as it may cause birth defects, the Office on Women’s Health report.

Some home care strategies may help reduce yeast infection symptoms or prevent the issue from coming back.

Probiotic yogurt may help reduce the amount of yeast in the body. A 2013 pilot study involving 24 women showed that eating 8 ounces of probiotic yogurt per day reduced the presence of Candida in some cases.

However, this was a small study with mixed results. Also, the women had HIV, so their health responses may not reflect those of the general population.

Addressing the cause of the infection is important, especially if the infection keeps coming back. A person may benefit from:

• using a condom during sex
• avoiding the overuse of antibiotics
• switching to a different method of birth control
• better managing underlying conditions, such as diabetes

A person should talk to a doctor if they notice symptoms of a yeast infection.

It is important to receive the right treatment for any infection, and correctly identifying the type of infection is the first step.

Yeast infections often cause changes to genital discharge and patches to form in the mouth or in skin folds.

A doctor can confirm the infection and recommend the best treatment, depending on the severity and the part of the body involved.

What does a yeast infection look like? Examples and treatments

The appearance of a yeast infection, or candidiasis, depends on its location. It can cause white patches in the mouth, flaking or crusting of the skin, and changes in genital discharge, which may look like cottage cheese.

In this article, we describe how a yeast infection visibly affects the body. We also look at other symptoms, treatments, and more.

A yeast infection occurs when fungi grow excessively in the body. This is particularly common in moist areas with less exposure, such as the mouth, vagina, or feet.

Often, yeast infections are caused by fungi from the Candida species — and according to the Centers for Disease Control and Prevention (CDC), Candida albicans is the type most likely to overgrow and cause an infection.

A vaginal yeast infection, or thrush, typically causes white discharge that is the texture of cottage cheese.

Other symptoms of a vaginal yeast infection include:

• painful urination
• soreness around the vagina
• inflammation and itchiness of the vagina and vulva
• pain during sex

These infections are common, with up to 75% of females having at least one diagnosed in their lifetimes.

Yeast infections can affect the penis, but this is less common. The symptoms tend to develop on the underside of the penis and include:

• scaling
• inflamed patches of skin
• a painful rash

A yeast infection can also cause inflammation near the head of the penis. This issue is called balanitis.

A person with balanitis may experience burning or itching and yellow or white discharge. In some people, the inflammation spreads to the shaft and the area under the foreskin.

Yeast infections are not considered sexually transmitted infections (STIs). However, it is possible for a person to develop a yeast infection after having oral, anal, or vaginal sex with someone who has the condition, especially if they are especially susceptible.

Around 15% of males who have unprotected sex with females experiencing yeast infections develop the infection themselves.

Oral thrush occurs when yeast grows excessively in the mouth or throat. Typically, a person develops white patches on the tongue, cheeks, back of the throat, or roof of the mouth.

Other symptoms of oral thrush include:

• soreness
• pain while eating or drinking
• a cotton-like feeling in the mouth
• cracked skin at the corners of the mouth
• a loss of taste

Most healthy adults do not develop oral thrush, but yeast infections in the mouth or esophagus are common in people with weakened immune systems.

Wearing dentures, smoking, and having dry mouth also elevate the risk of developing oral thrush.

The appearance of a yeast infection on the skin depends on the location, but this type of infection often causes patches of inflammation. These can vary in shape and size.

Sometimes, these patches itch, flake, or develop crusts, and pustules may appear around the edges.

A yeast infection can occur anywhere on the skin, but is most likely to develop in folds, such as:

• under the breasts
• under the arms
• in the groin
• under or in the buttocks
• in the navel
• on the scalp
• between the fingers and toes

If a yeast infection occurs on the scalp, it can cause crusty lesions that can lead to hair loss. Yeast infections can also cause diaper rash in babies.

Yeast infections can develop beneath the nails. An infected nail may turn white or yellow and start to separate from the nail bed.

When a yeast infection occurs under the nails, a person may experience:

• painful swelling
• pus
• nail loss

In small amounts, Candida fungi are not harmful. Many people have yeast on their skin and in their body. Other types of microbe, such as bacteria, help keep Candida from growing excessively.

However, certain factors can disrupt the body’s ability to keep Candida under control, such as:

• Antibiotics: Because antibiotics kill bacteria, the result may be that Candida fungi grow unchecked.
• Hormonal contraceptives: People who take hormonal birth control that contains estrogen are more likely to develop yeast infections.
• Pregnancy: Similarly, the hormonal changes during pregnancy increase the chances of developing yeast infections.
• A weak immune system: Young babies and people with immune disorders or conditions such as HIV may be more susceptible to yeast infections.
• Medications: Some medications and treatments, including steroids, immunosuppressants, and chemotherapy also weaken the immune system.
• Diabetes: Sugar helps yeast grow, so if a person frequently has high blood sugar levels, they are more likely to develop candidiasis.

Vaginal douches and sprays may also increase the risk of developing a vaginal yeast infection.

The treatment for a yeast infection varies, depending on the infection’s location and severity.

For mild, occasional infections, a person can try over-the-counter options, such as topical creams, nail treatments, or vaginal suppositories.

However, it is important to speak with a pharmacist or doctor first, because the symptoms of a vaginal yeast infection are similar to those of bacterial vaginosis and some STIs.

These issues do not respond to yeast infection treatments. They require different approaches and can cause serious health complications if a person does not receive the necessary care.

Also, frequently using antifungal medicine unnecessarily may reduce how effective it is in the future.

For more severe or reoccurring infections, a person may need prescription antifungal medication.

Pregnant women should not take the antifungal medicine fluconazole (Diflucan), as it may cause birth defects, the Office on Women’s Health report.

Some home care strategies may help reduce yeast infection symptoms or prevent the issue from coming back.

Probiotic yogurt may help reduce the amount of yeast in the body. A 2013 pilot study involving 24 women showed that eating 8 ounces of probiotic yogurt per day reduced the presence of Candida in some cases.

However, this was a small study with mixed results. Also, the women had HIV, so their health responses may not reflect those of the general population.

Addressing the cause of the infection is important, especially if the infection keeps coming back. A person may benefit from:

• using a condom during sex
• avoiding the overuse of antibiotics
• switching to a different method of birth control
• better managing underlying conditions, such as diabetes

A person should talk to a doctor if they notice symptoms of a yeast infection.

It is important to receive the right treatment for any infection, and correctly identifying the type of infection is the first step.

Yeast infections often cause changes to genital discharge and patches to form in the mouth or in skin folds.

A doctor can confirm the infection and recommend the best treatment, depending on the severity and the part of the body involved.

Fungal infections of the vagina in women: causes and treatment

Contents

• What are fungal diseases of the genital organs
• Causes of fungal diseases
• Risk factors
• Symptoms of fungal infections
• Treatment of fungal infections

The most common cause of female genital inflammation is a fungal infection. Fungal infection of the genital organs most often affects women of reproductive age from 21 to 40 years, its prevalence is constantly growing. Three-quarters of women experience symptoms of a vaginal fungal infection at least once in their lives ¹ . Let’s figure out which fungus affects the female genitals, why the disease occurs and how to overcome it.

What are fungal diseases of the genital organs

Various fungal infections are known to medicine, but it is the yeast-like fungus of the genus Candida that affects the genitals. Therefore, the disease is called “candidiasis” ² . Candidiasis can occur in both women and men, but women are more commonly affected ³ . Candida’s favorite habitat is the skin of the labia and vaginal mucosa ⁴ .

The genus Candida includes more than 170 species of the fungus. For effective treatment, you need to know which type caused the inflammation. Scientists have found that the infection of the vulva and vagina in 75-80% of cases causes C. albicans. In other cases, the cause of vulvovaginitis is other fungi, which, for convenience, are called non-albicans species. These include C. glabrata, C. tropicalis, C. krusei and others. Recently, their prevalence has increased. Non-albicans species cause recurrent vulvovaginitis, which is difficult to cure ¹ .

Causes of fungal diseases

Candida fungi are opportunistic pathogens. This means that they are part of the normal microflora of the vagina in healthy women. However, under the influence of external and internal conditions, opportunistic microbes can cause disease. It is believed that the main reason for the appearance of symptoms of vulvovaginal candidiasis is a decrease in the general and local immunity of a woman’s body ¹ .

Candidiasis develops in stages ¹ :

• the fungus attaches to the vaginal mucosa and begins to multiply rapidly;
• fungus cells overcome defense mechanisms and penetrate deep into tissues;
• fungal particles enter the blood vessels, spread through the body with the blood flow, form new lesions.

With vaginal candidiasis, infectious inflammation often affects only the surface layers of the mucosa. The fungus seeks, but cannot penetrate into the deeper layers, and the human body tries, but is not able to completely get rid of the pathogen. In this case, the infection can exist and periodically worsen over many years ¹ . The preservation of the infection is also facilitated by the fact that the inflammatory process in the vagina is rarely caused by one pathogen. In addition to the fungus, opportunistic bacteria, protozoa, sexually transmitted infections may also be present ⁵ .

Risk factors

An exacerbation of a fungal infection in the vagina occurs against the background of provoking factors.

Internal provoking factors include a decrease in immunity and changes in hormonal levels. Favorable conditions for the fungus occur during pregnancy, against the background of endocrine diseases (diabetes mellitus, thyroid pathology), allergies, pathologies of the gastrointestinal tract, lack of vitamins, when infected with sexually transmitted infections ¹ .

Of the drugs, thrush can be provoked by the long-term use of immunosuppressants, glucocorticoids, hormonal contraceptives, antibiotics, etc. ¹ Beneficial lactic acid bacteria die from antibiotics, and fungi are able to use antibacterial drugs as a source of nutrition and at the same time actively multiply ⁶ .

External factors that provoke thrush are trauma to the tissues of the vagina or conditions of high humidity ¹ :

• first sexual contact;
• wearing tight synthetic underwear;
• rinsing with a pressure shower;
• use of sprays;
• constant wearing of pads;
• the presence of an intrauterine device.

Vulvovaginal candidiasis is not a sexually transmitted infection. However, this does not exclude the sexual route of infection ³ .

Symptoms of fungal infections

Women with vulvovaginal candidiasis are most often concerned ¹ :

• an increase in the volume of secretions from the genital tract and a change in their consistency. They can be creamy, curdled, in the form of films and flakes, watery with crumbly inclusions, yellow or white with a sharp sour smell;
• intense itching in the area of ​​the labia, vagina, which leads to scratching;
• reddening of the skin of the vulva, swelling, rash and fissures on the labia;
• Painful urination due to contact of urine with inflamed skin and mucous membranes. Because of the pain, women are afraid to urinate, delay urination;
• pain and discomfort during intercourse.

With a recurrent course of candidiasis, the symptoms are not so bright: there may be no discharge, lesions are less common, mild swelling and redness. Due to chronic inflammation, the skin and mucous membranes change: areas of thickening or thinning, pigmentation, and dryness appear on them. The process can capture the inner thighs, the area around the anus. A week before menstruation, the symptoms intensify, and during menstruation they are relieved. Recurrent disease occurs in about 20% of women, with episodes of candidiasis occurring 4 or more times a year ¹ .

Treatment of fungal infections

The goal of treatment is to get rid of the pathogen. Before starting therapy, the doctor conducts a diagnosis. Usually there is enough questioning, examination and smear from the genital tract. In case of unsuccessful attempts at previous treatment, the pathogen is additionally cultured with an assessment of sensitivity to antimicrobial drugs ³ . Most cases of vulvovaginal candidiasis are amenable to topical treatment, that is, intravaginal forms of antifungals and antiseptics are used ¹ .

One of the drugs indicated for the treatment of inflammatory diseases of the vagina is Depantol ^® vaginal suppositories. Depantol ^® contains two active ingredients at once: chlorhexidine and dexpanthenol. Chlorhexidine is an antiseptic that is active against not only Candida fungi, but also concomitant infections: bacterial, protozoal, STIs. Dexpanthenol is a derivative of vitamin B ₅ . Provitamin B ₅ helps relieve inflammation and accelerate the regeneration of mucosal tissues, eliminates dryness ⁷ .

Recovery will be facilitated by continuous prevention of vulvovaginal candidiasis, which includes ¹ :

• use of barrier contraceptives;
• treatment of the underlying disease that caused the decrease in immunity;
• additional intake of antifungal agents during antibiotic treatment;
• rational full nutrition;
• reduction in alcohol consumption, smoking cessation;
• observance of intimate hygiene.

For daily care of the intimate area, instead of soap, special products are suitable – for example, Defemilema ^® with antibacterial components. Defemilema ^® supports the natural microflora of the intimate area and optimal pH levels, which helps to limit the growth of opportunistic organisms ⁸ .

14 days after the completion of treatment, even if nothing bothers you, you need to make sure that you are recovering. To do this, you need to visit a gynecologist and take a control swab from the genital tract ³ .

¹ Pestrikova T.Yu., Yurasova E.A. et al. Vulvovaginal candidiasis: a modern view of the problem. breast cancer. Mother and child No. 26 dated 01.12.2017 p. 1965-1970.

² Serov V.N., Tyutyunnik V.L. Vulvovaginal candidiasis: features of the course and principles of treatment. Pharmateka. 2005; 15:8-9.

³ Urogenital candidiasis Clinical recommendations. Year of approval 2020.

⁴ Makhnovets E.N. Modern ideas about vulvovaginal candidiasis and its therapy. Clinical dermatology and venereology. 2013;11(1):9‑15.

⁵ Prilepskaya V.N., Abakarova P.R. et al. Vulvovaginitis of mixed etiology and real clinical practice. Gynecology. 2020; 22(4): 82-87.

⁶ Tikhomirov A. L., Oleinik Ch.G. Vulvovaginal candidiasis: pathogenesis, clinic, diagnosis, modern principles of therapy. Attending doctor. #11/02.

⁷ Instructions for medical use Depantol® vaginal suppositories (dexpanthenol 100 mg + chlorhexidine 16 mg). Beat Reg. No. LSR-003902/07.

⁸ Instructions for use Defemilem® with antibacterial component.

Candida vulvovaginitis in the practice of a pediatric gynecologist | Uvarova E.V.

Z Candida is one of the most common lesions of the lower genital tract in girls. According to the luminaries of domestic pediatric gynecology, fungi of the genus Candida are found in more than half of the cases with chronic recurrent vulvovaginitis in girls of preschool age and in 24–25% of adolescents with inflammatory diseases of the genital organs (M.N. Kuznetsova, 1998; Yu.A. Gurkin, 2000).

Risk factors for candidiasis

Analysis of morbidity by age showed that the maximum proportion of candidal vulvovaginitis occurs in the neonatal period, at the age of 3, 7 years and adolescence . The first rise is explained by the possibility of vertical intrauterine transmission of the infection from the mother, the frequent use of antibiotics in the treatment of newborns without covering with antimycotic drugs, an increased risk of infection with nosocomial strains Candida. The second rise is due to a decrease in parents’ attention to the toilet of the external genitalia in children, as well as the most pronounced allergization of children aged 2–3 years. The third rise is associated with insufficient hygienic skills of girls, an increase in the number of colds and enterobiasis at the age of 7 years [Shushunova, V.G. Balasanyan, 2001]. However, it should be noted that, compared with other age periods, candidal vulvovaginitis in girls before menarche is extremely rare. In the pubertal period of life, a slight increase in the frequency of genital candidiasis, as a rule, is due to the inadequacy of hormonal ratios throughout the menstrual cycle. Deficiency of estrogenic saturation of the vaginal epithelium leads to insufficient development of lactobacilli, which are the main competitor of fungi in the vaginal biotope. A sharp increase in the incidence is observed in women who begin sexual relations.

An increased risk of Candida infections in children may be associated with a decrease in body resistance against the background of hypovitaminosis, an imbalance in the vaginal microflora, and immunodeficiency. In a number of diseases accompanied by immunosuppression of varying severity in children, a special place is occupied by acute and recurrent diseases of the oropharynx, systemic infectious diseases, endocrine pathology (hypogonadism, hypothyroidism, diabetes mellitus, adrenal hypofunction), impaired local and general circulation, neutropenia and agranulocytosis, dysbacteriosis intestines, hypovitaminosis and deficiency of trace elements, zinc, iron and magnesium. Candida vulvovaginitis in children is often a manifestation of colonization by fungi of the genus Candida of the oral cavity, intestines and surrounding skin, which, in turn, are due to the peculiarities of the diet, hygienic living conditions, the stay of girls in hospitals, infected with hospital strains of yeast fungi, etc. The occurrence of genital candidiasis is often promoted by prolonged and often uncontrolled use of antibiotics , corticosteroid drugs and cytostatics. As is known, taking most antibiotics without covering with antimycotic drugs leads to a decrease in the colonization resistance of the vagina and thereby facilitates the adhesion of fungi to the surface epithelium and their subsequent reproduction. In addition, antibiotics, corticosteroids and cytostatics cause a decrease in the content of secretory immunoglobulin, which provides local and general resistance of the child’s body to infection. Not only oral antibiotics predispose to candidiasis, but also local preparations containing iodine, as well as clindamycin, metronidazole.

The importance of sexual transmission of fungi is small, although infection from a partner with an acute stage of genital candidiasis is not denied.

A proven risk factor for the development of vaginal candidiasis is the physiological change in hormonal levels in women of young and childbearing age during pregnancy and when taking combined oral contraceptives, especially the first generation with a high content of estrogens. The absence of cyclical secretion of sex steroids, both during pregnancy and while taking combined oral contraceptives, leads to the fact that progesterone inhibits the process of blast transformation of lymphocytes to antigens Candida , and estrogens suppress the function of neutrophils. Along with this, fungal cells that have sex hormone receptors respond to changes in the hormonal environment by increasing their adhesive ability.

There is evidence of the development of vaginal candidiasis in sexually active adolescents using modern barrier methods of contraception (spermicides and condoms containing nonoxynol-9) and practicing oral sex (Nyirjesy P. et al., 1995).

Exciter

Fungi of the genus Candida belong to opportunistic aerobic microorganisms, devoid of the sexual stage of the life cycle and growing mainly in the yeast phase, i.e. multiplying budding. Thanks to this property, Candida species got their name – yeast fungi. The use of the term “yeast-like” from a modern point of view does not correspond to the true biology of the development of fungi of the genus Candida . Fungal cells, surrounded by a well-defined multi-layered membrane, can be round, ellipsoidal, oval or cylindrical in the yeast stage of development and hyphae-like in the mycelial or tissue stage of development Candida . Yeast fungi do not form true mycelium, but due to the contact of elongated cells, pseudomycelium and mitospores (asexual spores) of the fungal community are formed.

In the slightly acidic environment of the vagina at normal human body temperature, fungi of the genus Candida receive the most favorable conditions for growth and reproduction. In the mycelial phase Candida attach to the vaginal epithelium. Pseudomycelium has the ability to penetrate deep into up to 4-6 layers of the epithelium, which allows fungi to resist the natural factors of protection of the macroorganism and survive against the background of non-specific sanitation of the vagina. An increase in body temperature to 40–42°C helps to slow down the growth, but not the death of fungal cells. Growth arrest is possible when the fungus culture is heated to 50°C, and complete cell destruction occurs only during boiling.

Among the 150 known species Candida , only 20 strains are true pathogens of vaginal candidiasis, and the leaders among pathogens are only 4 species – Candida albicans , Candida tropicalis , Candida parapsil osis and Candida glabrata .

Fungi of the genus Candida are commensals of many warm-blooded animals, as they are part of the permanent microflora of the digestive tract, especially the large intestine. Candida albicans , Candida tropicalis and Candida parapsilosis can be found on the skin of a healthy person around natural openings, in the mouth, on the skin of the hands. In 10–30% of healthy women, “silent” carriage of Candida albicans and Candida glabrata is found in the vagina.

At the same time, according to a number of foreign authors (Cox R. A., 1997; Farrington P. E., 1997; Koumantakis E. E., 1997; Vexiau–Robert D., 1996), Candida was in second place among the causative agents of vulvovaginitis in children . According to A.Yu. Sergeeva et al. (2001), Candida albicans is isolated in at least 80% of cases of genital candidiasis and is superior in pathogenicity to other yeast species. Other types of fungi of the species Candida are isolated in 15-30% of cases of vulvovaginal candidiasis. Candida glabrata is the second after Candida albicans the causative agent of vaginal candidiasis, especially in patients who do not respond to the traditionally used treatment with imidazole drugs and, as a result, have a chronic, relapsing course of the disease. Conditional third place in the etiology of vaginal candidiasis mycologists assign Candida tropicalis , less commonly Candida krusei and Candida parapsilosis . It was noted that Candida parapsilosis most often inhabits the skin of the fingers, especially the bed under the free edge of the nails. This property of the fungi has led to an increased risk of transmission of the pathogen through the hands of medical personnel to instruments, syringes, droppers and solutions for parenteral nutrition, artificial endoprostheses, etc.

Accelerated spread of vaginal candidiasis caused by yeast fungi other than Candida albicans , gave rise to the term non-albicans candidiasis (NAC). Some researchers tend to attribute NAC to a complicated fungal infection of the genitals, explaining this interpretation by the frequent association of NAC with a chronic relapsing course of the disease, which is difficult to treat with traditional antimycotic drugs. There are a number of clinical, epidemiological and laboratory characteristics that allow the clinician to diagnose NAC. A similar diagnosis can be assumed in patients with relapses of candidal vulvovaginitis after repeated use of azole antimycotics, in patients complaining of itching with minor or subtle discharge from the genital tract, in girls and girls with manifestations of bacterial vaginosis, if a concomitant sexually transmitted infection is detected, and also in the absence of pseudomycelium of the fungus on microscopy of a vaginal smear.

Clinical picture

According to the course of the disease in children candidiasis, acute, chronic, recurrent and persistent (complicated) form of vulvovaginal candidiasis, as well as secondary candidiasis of the vulva and vagina a, scleroatrophic lichen, etc.).

Candidiasis is diagnosed only in the absence of an increase in the number of fungal colonies in 5–6 bacteriological cultures of the vaginal discharge, successively carried out at weekly intervals. The acute form exists no more than 2 months. The relapsing form should be understood as the presence of 4 or more episodes of vivid clinical manifestations of the disease in one year, alternating with latent periods of candidiasis. In the persistent form, the symptoms of the disease persist constantly, somewhat subsiding after the sanitation of the vagina or the antimycotic treatment.

The main symptoms of the disease in children are pronounced itching in the perineum and burning during urination . Itching can be constant or worse when in a warm bed, after a hot bath, after a long walk, when using synthetic underwear, sanitary pads. In the area of ​​the vulva and labia, itching is usually most intense and is accompanied by scratching. Soreness and burning in young girls can cause fear of urination, and in rare cases lead to the development of clinical manifestations of acute urinary retention. Severe constant itching often leads to sleep disturbance and increased irritability of the girl, up to the appearance of pronounced neurotic reactions. In sexually active adolescents, pain and a burning sensation in the vulva and vagina lead to fear of sexual intercourse, which also contributes to the formation of neurotic disorders and pathological attitudes towards sex.

When examining a patient with acute candidal vulvovaginitis marked hyperemia and swelling of the external genitalia, vulvar ring and vaginal walls. Slightly creamy or cheesy vaginal discharge has a mild sour smell. Less often, the discharge acquires a watery consistency with an admixture of cheesy crumbs. For children, the pseudomembranous form of the disease, called “thrush” in everyday life, is more characteristic. Between the labia minora, in the vestibule and on the walls of the vagina, islands of a thin grayish-whitish plaque are determined, which, unlike diphtheria lesions of the mucous membranes, is easily removed, exposing bleeding areas of bright hyperemia. Maceration, large red erosive lesions of the skin with a whitish exfoliating epidermis along the periphery (candidal intertrigo), scratching and swelling sometimes extend to the skin of the perineum in the region of the inguinal folds and inner thighs. The affected area has a lilac hue, lacquer sheen, confluent erosions are not accompanied by abundant weeping, are clearly delineated from the surrounding unaffected tissue, small vesicles, pustules or erythematous-squamous elements can be found along the periphery of the foci.

Chronic stages of candidiasis are characterized by less prevalence of lesions, less intense hyperemia and swelling, few plaque films. In menstruating untreated girls, the symptoms of candidal vulvovaginitis resume before the next menstruation and subside somewhat on menstrual days. Chronic forms are characterized by the presence of infiltration and cracks in the clitoris, labia, perineum, and perianal region. Shine and lichenification (rough folds) of the skin of the labia and around the entrance to the vagina appears. Changes in the external genitalia may resemble kraurosis, as the skin and mucous membranes turn brown, become flabby and atrophic, the labia major and minor are smoothed and wrinkled, and the vestibule narrows. With an erythematous (atrophic) variety of chronic candidiasis of the genitals, vaginal discharge and plaque are absent, and spots of thin, hyperemic or slightly cyanotic epithelium are determined on the mucous membrane of the vestibule and walls of the vagina. Along with damage to the genital organs, candidal stomatitis, intestinal candidiasis, and candidal tonsillitis can be detected.

Laboratory diagnostics

Laboratory diagnosis of candidal vulvovaginitis requires direct microscopy of fresh material taken mainly from the anterior wall of the vagina. For microscopy, both unstained native preparations prepared in a drop of saline, and smears stained by Gram, Romanovsky or methylene blue are used. Pay attention to the presence of pseudomycelium and yeast cells, the number of leukocytes, the composition of associates. However, it should be remembered that the detection of vegetative forms (budding cells and pseudomycelium) allows determining the number of fungi, but does not provide information about the pathogenic properties and activity of the infectious process. On the other hand, the absence of pseudomycelia is not always a criterion for excluding candidiasis, since the latter could be caused by other species Candida . Positive results of microscopy correspond to the excess of the content of colony-forming units (CFU) of fungi more than 10 ³ in 1 ml of material. The absence of clinical manifestations in the isolation of more than 10 ⁴ CFU / ml of fungi should be regarded as asymptomatic candida. In the presence of a clinical picture, supported by a positive smear microscopy, candidal lesions of the genitals are beyond doubt. The cultural diagnostic method (as well as the PCR method) does not apply to highly specific and standard methods for diagnosing candidal vulvovaginitis. However, only with the help of these methods is the identification of the genus and species of fungi and an adequate subsequent choice of a systemic antimycotic therapeutic effect possible.

Treatment

For the treatment of children with candidal vulvovaginitis, the principle of mandatory elimination (eradication) of the pathogen is applied. It should be remembered that, first of all, it is necessary to create conditions that are detrimental to the life of the cells of the fungus of the genus Candida , and only then eliminate the disorders of the vaginal microcenosis and correct background conditions and diseases. Moreover, given the easy colonization of Candida , it is important to understand that the complete destruction of fungal cells in vivo is not possible. The expected result of treatment is the removal of the pathogen in order to eliminate the main clinical manifestations, or to block the reproduction of fungi for the duration of one of the factors predisposing to the development of candidal lesions of the mucous membranes (prevention).

So-called local forms are used to prevent colonization of the mucous membranes of the mouth, intestines and vagina. Oral polyene antibiotics (nystatin, amphotericin B, natamycin, levorin) are usually used. These drugs do not have a systemic effect, but only sanitize the intestinal tube, since their absorption in the intestine is minimal. To protect against intestinal hypercolonization by fungi of the genus Candida a good effect is provided by oral administration of imidazole drugs (clotrimazole, ketoconazole, miconazole). It is interesting to note that the use of eubiotics to correct intestinal dysbiosis in vaginal candidiasis has not received clear scientific confirmation, although it is still actively recommended by pediatricians and pediatric gynecologists. Preventive sanitation of the vagina is possible with the help of vaginal tablets, suppositories, gels, solutions and ointments containing any antifungal agents. At the same time, it should be noted that in patients with long-acting and pronounced predisposing factors for candidiasis, polyene antibiotics and local forms are not very effective. The best means of prevention for such patients are antifungal drugs of the triazole series, in particular, itraconazole and fluconazole ( Mikosist etc.).

The mechanism of action of Mycosyst is due to the inhibition of the synthesis of ergosterol, which is part of the cell membrane of fungi. The drug has a highly specific effect on fungal enzymes dependent on cytochrome P450. Treatment with Mycosyst may be started until culture and other laboratory results are available , further dose adjustment is necessary. Mycosist in children and adolescents is prescribed in a dose not exceeding the daily dose for adults.

The results of numerous studies indicate a high efficiency (up to 99%) of a single dose of fluconazole in patients with unchanged immunity.

Most cases of acute and severe fungal vulvovaginitis in children and adolescents can be treated with topical antimycotics and antiseptics. The advantage of locally applied drugs is systemic safety, high concentrations of drugs in the lesion, the rapid disappearance of painful symptoms of the disease, and a lower likelihood of developing resistance Candida . Topical preparations are more diverse in composition than systemic antimycotics, since many of them, due to systemic toxicity, are suitable only for local use. According to the source of receipt, all antifungal drugs are distributed to the waste products of microorganisms and synthesized chemicals.

For local treatment of vulvovaginal candidiasis in girls, suppositories with polyene antibiotics (nystatin, levorin, natamycin) and azole preparations (clotrimazole, etc.), which are injected daily into the vagina by a pediatric gynecologist or a nurse trained by him, can be used.

Before the first administration of suppositories or vaginal tablets, it is desirable to irrigate the vagina through a catheter with a solution of baking soda and boric acid, antiseptics with a fungistatic effect (octenisept solution, 2% sodium tetraborate solution, miramistin solution, aqueous solutions of aniline dyes). Long-term use of local antiseptics most often turns out to be ineffective, since the effect of the application ends soon after they are canceled.

Duration of treatment should be 6 days for natamycin and clotrimazole and at least 10 days for nystatin, levorin and miconazole, which is not always acceptable for outpatient management of young girls. Therefore, suppositories with econazole are increasingly used for local treatment of candidal vulvovaginitis in children, which are injected deep into the vagina, 1 suppository at night for 3 days. Gyno-travogen and gyno-trozid, despite their prolonged (up to 1 week) action after a single injection of 1 suppository, turned out to be less popular among pediatric gynecologists, which may be due to alertness to the allergic reactions noted in the annotation and the high cost of drugs. The use of ketoconazole (nizoral) in children is limited due to its pronounced side effects. In patients with vulvovaginitis and severe damage to the skin of the external genital organs, antibiotics and antimycotics can be administered not only deep into the vagina, but also applied in the form of gels and ointments to the vulva, the region of the external opening of the urethra and the perineum.

If there is an association of pathogenic fungi of the genus Candida with other urogenital infections, it is advisable to use combination preparations simultaneously containing an antimycotic and other antimicrobial agents. In the practice of a pediatric gynecologist, it makes sense to use Macmiror-complex (nitrofurantel and nystatin), terzhinan (ternidazole with neomycin, nystatin and prednisolone), polygynax (neomycin, nystatin and polymyxin), klion-D (metronidazole) to eliminate a mixed infection of the lower genital tract. and miconazole nitrate). The use of combined local preparations in some cases avoids the prescription of oral antibiotics that exacerbate vaginal candidiasis.

It is important to note that most topical azole derivatives are not recommended for use in young women who wish to continue their pregnancy. If necessary, their use in the first trimester of the gestational process is allowed. In addition, it should be remembered that the appointment of imidazole derivatives together with polyene antibiotics causes a mutual weakening of the effects.

In girls with chronic, recurrent, complicated or persistent superficial candidiasis, including candidal vulvovaginitis, it is more appropriate combined use of systemic and local forms of antimycotics of the same line, or parallel administration of local antiseptics and fungistatics with systemic antifungal drugs. The advantage of the latter is the convenience of prescribing, minimizing the duration of treatment, as well as the possibility of a highly effective effect on the pathogen at any localization.

Among systemic antimycotics, a special place is occupied by triazole compounds , of which fluconazole ( Mikosist etc.). Fluconazole is considered the drug of choice due to its high selective activity against Candida albicans , pharmacokinetics and ease of use. Since triazole compounds are well absorbed, oral administration of the drug should be preferred. Parenteral administration is acceptable if it is impossible to take the drug by mouth. In case of uncomplicated candidal vulvovaginitis, it is enough to use the drug once, and in patients with a torpid or severe course of the disease, the duration of treatment depends on the species of the fungus in the family Candida and from the depth of the lesion. The pediatric dose of the drug for candidiasis of the skin and vagina is 2 mg / kg of body weight of the child, while in children over 12 years of age, a standard daily dose of 50 or 150 mg of fluconazole should be used. The general recommendation for the treatment of complicated forms of genital candidiasis is to increase the duration of the drug in standard doses up to 10-14 days.

It should be remembered that the most common cause of treatment failure candidal vulvovaginitis is the failure to comply with the recommendations of the doctor and the unsystematic self-treatment with local antisepics and antimycotics before going to the doctor. The situation was complicated by the penetration of low-quality generics, and sometimes even counterfeit drugs, into the Russian pharmacopoeial market. Along with this, a frequent mistake of the medical stage of managing sick children is ignoring the bacteriological examination of the sowing of the contents of the vagina in order to identify the species of the pathogen and determine its sensitivity to the main antimycotic drugs. The fight against recurrence of fungal vulvovaginitis should include mandatory correction of underlying and predisposing conditions . In this regard, it is of interest to use the immunomodulator Gepon, which has interferon-inducing activity and the ability to quickly eliminate the most characteristic clinical manifestations of candidal vulvovaginitis (itching, soreness, redness of the inflamed tissue significantly decreased already by the 2nd day of the drug). Presumably, Gepon inhibits the production of proteinases by fungal cells, which are one of the leading components of inflammation. According to Perlamutrov Yu.N. and his colleagues (2001), Tishchenko A.L. et al. (2001), triple irrigation of 5 ml of a 0.