Risk and Prevention | Invasive Candidiasis | Candidiasis | Types of Diseases | Fungal Diseases

Groups at risk for invasive candidiasis

People who are at high risk for developing invasive candidiasis include those who:¹

• Have spent a lot of time in the intensive care unit (ICU)
• Have a central venous catheter
• Have a weakened immune system (for example, people on cancer chemotherapy, people who have had an organ transplant, and people with low white blood cell counts)
• Have recently had surgery, especially multiple abdominal surgeries
• Have recently received lots of antibiotics in the hospital
• Receive total parenteral nutrition (food through a vein)
• Have kidney failure or are on hemodialysis
• Have diabetes
• Are pre-term babies

People who inject drugs are also at risk for invasive candidiasis, especially for bloodstream infections, heart valve infections, and bone and joint infections. ⁶

Is invasive candidiasis contagious?

Invasive candidiasis doesn’t spread directly from person to person. However, some species of the fungus that causes invasive candidiasis normally live on skin, so it’s possible that Candida can be passed from one person to another and possibly cause an infection in someone who is at high risk.²,³

Preventing invasive candidiasis

• Antifungal medication. If you’re at high risk for developing invasive candidiasis, your healthcare provider may prescribe antifungal medication to prevent the infection. This is called “antifungal prophylaxis,” and it is typically recommended for:⁴
  • Some organ transplant patients
  • Certain patients in the intensive care unit (ICU)
  • Patients who are on certain types of chemotherapy or have low white blood cell counts (neutropenia)
  • Patients who have a stem cell or bone marrow transplant and have low white blood cell counts (neutropenia)
• Some doctors may also consider giving antifungal prophylaxis to very low birth weight infants (less than 2. 2 pounds) in nurseries with high rates of invasive candidiasis.
• Be a safe patient. There are some actions that you can take to help protect yourself from infections, including:
  • Speak up. Patients and caregivers can ask whether a central venous catheter (central line) is needed, and if so, how long it should stay in place. Tell your doctor if the skin around the catheter becomes red or painful.
  • Keep hands clean.  Be sure everyone cleans their hands before touching you. Washing hands can prevent the spread of germs.
  • For more tips, please see CDC’s webpage about What You Can Do to Be a Safe Patient.
• Healthcare providers can follow CDC-recommended infection control practices every time they work with a central line. For more prevention information, please visit CDC’s Healthcare-Associated Infections website.

1. Kullberg BJ, Arendrup MC. Invasive candidiasisexternal icon. N Engl J Med 2015; 373:1445-1456.
2. Pappas PG, Kauffman CA, Andes DR, Clark CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of Americaexternal icon. Clin Infect Dis. 2016;62:e1-50.
3. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problemexternal icon. Clin Microbiol Rev. 2007 Jan;20(1):133-63.
4. Strausbaugh LJ, Sewell DL, Ward TT, Pfaller MA, Heitzman T, Tjoelker R. High frequency of yeast carriage on hands of hospital personnelexternal icon. J Clin Microbiol. 1994 Sep;32(9):2299-300.
5. Yildirim M, Sahin I, Kucukbayrak A, Ozdemir D, Tevfik Yavuz M, Oksuz S, et al. Hand carriage of Candida species and risk factors in hospital personnelexternal icon. Mycoses. 2007 May;50(3):189-92.
6. Zhang AY, Shrum S, Williams S, Petnic S, Nadle J, Johnston H, et al. The changing epidemiology of candidemia in the United States: injection drug use as an increasingly common risk factor – active surveillance in selected sites, United States, 2014–17external icon.  Clin Infect Dis. 2019 Nov.

Page last reviewed: November 18, 2020

Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

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• Fungal Meningitis
• National Center for Emerging and Zoonotic Infectious Disease
• Division of Foodborne, Waterborne, and Environmental Diseases
• Mycotic Diseases Branch

Statistics | Invasive Candidiasis | Candidiasis | Types of Diseases | Fungal Diseases

Public health surveillance for candidemia in the United States

Since 2008, CDC has performed continuous, active population-based surveillance for Candida bloodstream infections (candidemia) through the Emerging Infections Program (EIP). EIP is a network of 10 state health departments and their collaborators in local health departments, academic institutions, other federal agencies, public health and clinical laboratories, and healthcare facilities.

Active, population-based surveillance for candidemia is being conducted in 10 EIP sites: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee (Figure 1). CDC and its partners recruit laboratories and hospitals serving the counties under surveillance to submit reports of candidemia in patients within the surveillance area.

Learn more about methods used for CDC’s candidemia surveillance through EIP.

Figure 1. Emerging Infections Program sites where candidemia surveillance is being conducted; dark green represents counties under surveillance at each EIP site.

Through this program, CDC monitors epidemiologic trends in candidemia and performs species confirmation and susceptibility testing on all available Candida bloodstream isolates to:

• Track incidence of candidemia and monitor laboratory and epidemiologic trends
• Identify new risk factors for candidemia
• Detect changes in resistance to antifungal agents and communicate these results back to submitting laboratories
• Determine the burden (number of cases, treatment costs, etc. ) of infections caused by antimicrobial-resistant Candida species and understand the causes of resistance. Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow.
• Identify areas where candidemia prevention and intervention strategies should be focused

CDC also collects data on healthcare-associated infections, including central line-associated Candida infections, through the National Healthcare Safety Network (NHSN), the largest healthcare-associated infection reporting system in the United States.

Candidemia trends in the United States

Although there are notable differences by site, overall candidemia incidence has declined. Candidemia incidence declined during 2008–2013 and then stabilized at approximately 9 cases per 100,000 population per year during 2013–2017.^3,4 The observed declines in candidemia during 2008–2013 may be related to healthcare delivery improvements such as those involving catheter care and maintenance. ³ Increases in incidence for certain surveillance areas may be due to increases in the number of candidemia cases related to injection drug use, which has recently re-emerged as a risk factor for candidemia.^5-7

Demographic trends

Candidemia rates by age group have recently changed. Rates decreased significantly among infants and the elderly during 2009–2012, but have remained more stable since 2012.^8,9 The reasons for the decline in candidemia rates in some age groups are not fully understood but might be related to factors such as changes in prophylaxis guidelines and improved infection control practices, such as hand hygiene and catheter care. Among all ages, candidemia rates are approximately twice as high among Black people compared with other races/ethnicities. The differences by race might be due to differences in underlying conditions, socioeconomic status, healthcare access and availability, or other factor.

Learn more about candidemia incidence rates by age group and race.

Trends in species distribution

Up to 95% of all invasive Candida infections in the United States are caused by five species of Candida: C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei. The proportion of infections caused by each species varies by geographic region and by patient population.¹⁰ Although C. albicans is still the leading cause of candidemia in the United States, increasing proportions of cases in recent years have been attributed to non-albicans species that are often resistant to antifungal drugs.^11-13 Altogether, non-C. albicans species cause approximately two-thirds of candidemia cases in the United States.^3,11 In some locations, C. glabrata is the most common species. Since 2015, an emerging species called Candida auris (C. auris) has been an increasing cause of invasive Candida infections in the United States.¹⁴

Learn more about Candida species distribution.

Trends in antimicrobial resistance

Some types of Candida are increasingly resistant to the first-line and second-line antifungal medications, such as fluconazole and the echinocandins (anidulafungin, caspofungin, and micafungin). About 7% of all Candida bloodstream isolates tested at CDC are resistant to fluconazole. More than 70% of these resistant isolates are the species C. glabrata or C. krusei.^11,15 CDC’s surveillance data indicate that the proportion of Candida isolates resistant to fluconazole has remained fairly constant over the past 20 years.^11,16,17 Echinocandin resistance, however, appears to be emerging, especially among C. glabrata isolates. Approximately 3% of C. glabrata isolates are resistant to echinocandins, but the percentage may be higher in some hospitals. This is especially concerning because echinocandins are the first-line treatment for C. glabrata, which already has high levels of resistance to fluconazole.¹⁵

Learn more about trends in antimicrobial resistance in Candida spp. isolates.

Deaths due to invasive candidiasis

Invasive Candida infections are often associated with high rates of morbidity and mortality, as well as increased length of hospital stay. CDC’s surveillance data indicate that the in-hospital all-cause (crude) mortality among people with candidemia is approximately 25%. However, because people who develop invasive candidiasis are typically already sick with other medical conditions, it can be difficult to determine the proportion of deaths directly attributable to the infection. One study estimated the candidemia attributed mortality to be 19–24%.¹⁸

Candida infections lead to high costs

Candida is a leading cause of healthcare-associated bloodstream infections in U. S. hospitals. Invasive Candida infections are costly for patients and healthcare facilities because of the long hospital stays. Each case of candidemia is estimated to result in an additional 3 to 13 days of hospitalization and $6,000 to $29,000 in healthcare costs.¹⁹

Invasive candidiasis outbreaks

Most cases of invasive candidiasis are not associated with outbreaks. However, periodic outbreaks of C. parapsilosis infection have been reported for decades, including clusters of invasive candidiasis in neonatal intensive care units likely transmitted via healthcare workers’ hands.^20-22 Recently, Candida auris has caused outbreaks of invasive infections around the world likely because of its ability to colonize patient skin and persist on healthcare surfaces. Of concern, C. auris is commonly resistant to antifungal medications, and some disinfectants used in healthcare settings do not kill C. auris.

Diagnosis and treatment of urogenital candidiasis :: DIFFICULT PATIENT

А. М. Savicheva
GU NIIAG im. BEFORE. Otta RAMS, St. Petersburg

Urogenital candidiasis is a disease of the mucous membranes of the genitals caused by yeast-like fungi of the genus Candida. Candidiasis is common, and about 75% of all women have experienced at least one episode of this disease in their lives. Candidiasis is not an STI, but may indicate changes in immune and/or hormonal status. It should be emphasized that about 20% of healthy women are carriers of yeast-like fungi in the vagina, which does not require treatment.

Etiology
Candida yeast-like fungi belong to the Deuteromycetes imperfect fungi family Cryptococcaceae, as they do not have sexual forms of reproduction and sexual spores. Morphologically, they are unicellular organisms, the cells have a round or oval shape, and also form, with a linear arrangement of budding elements, filamentous forms – hyphae and pseudohyphae. Like all eukaryotes, fungi of the genus Candida have a well-shaped nucleus, sometimes several nuclei. The cell is surrounded by a cell wall containing chitin and cellulose. The size of a yeast cell is 3-4 microns, pseudohyphae – 5-10 microns. In addition to pseudohyphae, candida can form true hyphae, which have parallel walls and septa, while pseudohyphae taper at the ends.
In the study of vaginal discharge, the most commonly isolated species is Candida albicans (about 90%), as well as other species of this genus – C. tropicalis, C. krusei, C. parapsilosis, C. guillermondi and fungi of the genus Torulopsis – Torulopsis glabrata. Currently, T. glabrata is recognized as a normal part of the vaginal biocenosis.
Yeast-like fungi of the genus Candida are opportunistic, sporeless dimorphic fungi that are facultative anaerobes. They tolerate drying and freezing well. They reproduce by multipolar budding. When tissues are invaded by fungi of the genus Candida, they often transform into thin filamentous forms, forming pseudomycelium, which is formed as a result of incomplete budding of elongated yeast cells. At the same time, the formed daughter cell retains its connection with the mother cell due to the narrow isthmus.
Fungi of the genus Candida are found in the air, soil, vegetables, fruits, confectionery. They are representatives of the normal intestinal microflora, oral mucosa, external genitalia and areas adjacent to natural openings, which are associated with natural reservoirs of fungi of the genus Candida. Thus, about 50% of clinically healthy individuals are carriers of fungi of the genus Candida on the oral mucosa. A small number of yeast cells in the stool (from 100 to 1000 per 1 g of feces) are found in clinically healthy individuals. In other areas of the skin and in the bronchial tract in healthy individuals, they are rarely sown and in small quantities. Other representatives of the normal microflora are in a competitive relationship with fungi of the genus Candida.

Pathogenesis
Colonization of the mucous membranes of the genitals by yeast-like fungi of the genus Candida, like overt candidiasis, is a manifestation of the weakening of the “host” defense. It has long been known that the most susceptible to this disease, caused by an opportunistic yeast-like fungus, are very young (infants), very old or very sick people. Candidiasis, first of all, is a “disease of the sick.” Endogenous factors predisposing to this mycosis include endocrine diseases (hypercorticism, diabetes mellitus, obesity, hypothyroidism and hypoparathyroidism), severe general diseases (lymphoma, leukemia, HIV infection, etc.), pathological pregnancy. Currently, the use of antibiotics with a wide spectrum of antibacterial action, glucocorticosteroids, cytostatics, and hormonal contraception most often contributes to the development of candidiasis. A number of exogenous factors also contribute to the development of candidiasis. These include high temperature and excessive humidity, leading to maceration of the skin and mucous membranes, microtrauma, damage to the skin and mucous membranes by chemicals, etc. Exposure to several predisposing factors (endogenous and exogenous) at the same time significantly increases the risk of developing candidiasis.
Infection of the fetus and newborn child usually occurs intranatally when passing through the infected birth canal of the mother, along with this, the possibility of a transplacental and ascending route of infection (congenital candidiasis) has also been proven. It is also possible the development of postnatal candidiasis in newborns. Infection of the fetus and newborn child is facilitated by the presence of vulvovaginal candidiasis in the mother, especially in the third trimester of pregnancy, the presence of concomitant diseases, especially diabetes.
The occurrence of candidiasis in adults most often occurs as a result of autogenous superinfection, although exogenous superinfection (genital, perigenital areas) can also occur. Dysbacteriosis and violation of the protective system of the surface of the mucous membrane and skin facilitates the attachment (adhesion) of the fungus to epitheliocytes and its penetration through the epithelial barrier.

Clinical picture
Vulvovaginal candidiasis is characterized by the formation of a whitish coating on the hyperemic mucous membrane of the vulva and vagina (as with thrush). Characteristic crumbly “curdled” white discharge appears. Patients are disturbed by excruciating itching and burning. Perhaps burning of the vulva during urination and pain during sexual contact. The defeat of the vulva and vagina with yeast-like fungi is characterized by great persistence and a tendency to relapse. In a chronically relapsing disease, an exacerbation is often observed before the onset of menstruation.
Yeast vulvovaginitis usually develops with persistent treatment with antibacterial drugs, in patients with decompensated diabetes mellitus and pregnant women, as well as with prolonged use of hormonal contraceptives. It is possible to transmit the disease from a wife to her husband, who develops yeast balanoposthitis. Candidiasis urethritis is rare.
In newborns, clinical manifestations of the disease develop immediately after birth (with congenital candidiasis) or later in the form of local skin lesions and mucous or severe visceral lesions up to sepsis. However, most often in the presence of vulvovaginal candidiasis in the mother, the child develops candidiasis.

Diagnosis
For the diagnosis of urogenital candidal infection, microscopic methods, cultural methods with the isolation of yeast-like fungi, identification of candida species, a test to determine the sensitivity of candida to antimycotic drugs, molecular biological methods (PCR) for the detection of Candida albicans are used.
The material for the study is the discharge of the vagina, cervical canal, urethra, as well as urine. It is necessary to remember the possibility of rapid reproduction of the fungus and start the study as soon as possible after aseptic sampling. To take the material with a vaginal swab or inoculation loop in 10 µl, the discharge is taken from the vaginal fornix and the side wall of the vagina. For microscopic examination, the material is placed on two glass slides, for cultural diagnostics – in a special transport medium.
The microscopic method is preferred for laboratory diagnosis of vulvovaginal candidiasis, since 20% of healthy women have candida in the vagina, which will also grow when sowing, which will give rise to an unreasonable diagnosis of vaginal candidiasis. The cultural method is useful in the chronic relapsing course of the disease, in the study of the action of drugs, in the atypical course of the disease, when other possible pathogens are excluded.
For microscopic examination, the doctor sends to the laboratory a smear preparation from the vaginal discharge and a test tube with a cotton swab, which was used to take the material from the lateral or posterior fornix of the vagina. The middle portion of freely released urine is also sent, taken into a sterile test tube.
For microscopy, unstained preparations are used, as well as preparations treated with KOH, stained according to Gram, Romanovsky-Giemsa, methylene blue.
The diagnosis is based on the detection of elements of the fungus: single budding cells, pseudomycelium, other morphological structures (blastoconidia, pseudohyphae).
Candida grows well on simple nutrient media, including blood agar, wort agar, potato agar, Sabouraud’s medium with glucose or maltose. Candida colonies are moist, cream-colored, raised, shiny or opaque. Candida species are distinguished by the assimilation of carbohydrates as the sole source of nutrition and by the fermentation of carbohydrates with the formation of acid and, in some cases, acid and gas. In table. 1 shows the ability of different types of candida to ferment carbohydrates.
The clinician decides on the significance of the detected yeast-like fungi.
For cultural diagnostics, the clinical material is inoculated on 2-3 media (blood agar, wort agar, liquid and solid Sabouraud media, Vagicult media from Orion Diagnostica (Finland). Incubated at a temperature of +37 ∞C, since unlike fungi pathogenic to humans, this regimen is unfavorable for saprophytes
Assess semi-quantitative growth on agar media and weave pure cultures for subsequent identification. coverslip, leave the culture for 18-48 hours at room temperature, after which they are examined under a phase contrast microscope or with the condenser lowered. The shape of the pseudohyphae and the location of the pseudohyphae along the pseudohyphae are assessed.0003 For a quick detection of C. albicans, capillary culture is performed on medium with horse or fetal calf serum. Already after two hours of incubation, this type of candida (the most frequent) gives rise to pseudohyphae.
If further precise identification is required, use carbohydrate kits to check their utilization and fermentation. Currently, diagnostic kits are being produced for both computer and visual recording of the results of carbohydrate fermentation.
It should be emphasized that PCR for the diagnosis of urogenital candidiasis should be used with caution. A positive test result for the presence of C. albicans, obtained by PCR, may only indicate the colonization of the vagina by these fungi and is not evidence of the presence of candidiasis.

Treatment
To prescribe a rational treatment, it is necessary to take into account the clinical form of candidiasis, its prevalence and identified predisposing factors (general and local). With superficial candidiasis of the genitals and the perigenital area, the degree of contamination with yeast of the genus Candida of the gastrointestinal tract should be determined. With massive colonization of the gastrointestinal tract by fungi of the genus Candida, it is advisable to prescribe drugs to suppress their growth (natamycin, levorin, nystatin, etc.).
In acute vulvovaginal candidiasis, lotions and douches with a 0.05% solution of chlorhexidine bigluconate or a 0.01% solution of miramistin have a rapid therapeutic effect. Antifungal azole derivatives (isoconazole, econazole, etc.) and polyene antibiotics (natamycin) are also used externally in appropriate forms: suppositories, vaginal balls, vaginal tablets and cream with a special applicator.
With simultaneous damage to the skin folds, external therapy is carried out depending on the severity of inflammation. First, lotions are prescribed (0.05% solution of chlorhexidine bigluconate, or 0.01% solution of miramistin, or 0. 04% solution of zinc sulfate), and then lubrication of the foci with 1-2% aqueous or alcoholic solution of aniline dye or 1-2% other anti-candidiasis drug in the form of a paste, gel or hydrophilic cream.
General anti-candidiasis therapy is prescribed for patients with recurrent vulvovaginal candidiasis, as well as for candidiasis that occurs during treatment with antibacterial drugs, glucocorticoids and cytostatics, decompensated diabetes mellitus, cancer, blood diseases, HIV infection, etc. Azole derivatives are recommended, which are well absorbed from the intestine to the systemic circulation. Fluconazole (Mikoflucan) is prescribed 50 mg daily or 150 mg once a week for 2-4 weeks; itraconazole – 100 mg once a day for 15 days; ketoconazole – 200 mg (one tablet) once a day for 2-3 weeks. Known antifungal antibiotics of the polyene series (nystatin, natamycin, levorin) are practically insoluble in water, therefore they are poorly absorbed from the intestine.
In case of recurrent vulvovaginal candidiasis, in addition to identifying contributing factors (diabetes mellitus, abnormal pregnancy, obesity, hormonal contraception, “hidden” infection, etc. ), fluconazole (Micoflucan) is prescribed at a dose of 150 mg once a month, and with frequent relapses – itraconazole 200 mg once a day for three days or 200 mg twice a day for one day; Ketoconazole 400 mg once daily for 5 days may also be prescribed. In table. 2 shows the treatment regimen for vulvovaginal candidiasis.

Prevention
It is important to prevent candidiasis in persons with a combination of several predisposing factors: immunodeficiency, blood disease, neoplasm, condition after major operations, as well as after massive treatment with antibiotics, glucocorticoid hormones, cytostatics, who received ionizing radiation. Great importance is attached to the treatment of intestinal dysbacteriosis, the detection and treatment of candidiasis in pregnant women, the treatment of persons with genital candidiasis and their sexual partners, etc.
In case of persistent course and recurrence of urogenital candidiasis, it is necessary to conduct an examination and treatment with related specialists (possibly a gastroenterologist, endocrinologist, oncologist, etc. ).

Vulvovaginal candidiasis | Dikul Center

Vulvovaginal candidiasis is a fungal infection that causes irritation, discharge, and severe itching in the vagina and vulva, the tissues at the entrance to the vagina.

Vaginal yeast infection develops in up to 70% of women during their lifetime, and many of these episodes may occur several times.

Vaginal candidiasis is not a sexually transmitted infection. But the first regular sexual life significantly increases the risk of developing candidiasis. Also, candidiasis can be associated with oral-genital sex.

Vaginal yeast infections respond well to treatment. In the presence of recurrent yeast infection – four or more times during the year – the patient may need long-term maintenance therapy.

Symptoms

Candidiasis symptoms can range from mild to moderate and include:

• Itching and irritation in the vagina and vulva
• Burning sensation when urinating or during intercourse.
• Redness and swelling of the vulva
• Vaginal pain and tenderness
• Vaginal rash
• Odorless thick white curdled vaginal discharge.
• Watery vaginal discharge

Complicated candidiasis

A woman may have a yeast infection if:

• There are severe symptoms such as extensive redness, swelling and itching, which are complicated by tears, cracks or ulcers.
• If the yeast infection develops more than four times a year
• Infection due to an atypical fungus
• Pregnancy
• Uncontrolled diabetes
• Weakening of the immune system due to the use of certain medications or the presence of serious diseases such as HIV infection.

When to see a doctor?

You need to make an appointment with a doctor if:

• Symptoms of a yeast infection appear for the first time
• It is doubtful that this is a fungal infection
• Symptoms do not improve after taking over-the-counter antifungal vaginal creams or suppositories.
• Other symptoms appear

Causes

Candida albicans is the main cause of most vaginal yeast infections.

The vagina is known to naturally contain a balanced mix of yeast, including Candida, and bacteria. Some bacteria (lactobacilli) prevent yeast from growing.

But this balance can be upset. Overgrowth of fungi or their penetration into the deeper layers of the mucous tissue of the vagina can lead to the development of symptoms of a yeast infection.

Yeast overgrowth can be caused by:

• Use of antibiotics, which can upset the balance of the natural vaginal flora
• Pregnancy
• Uncontrolled diabetes
• Immune system disorders
• Taking contraceptives or hormone therapy, which can increase the level of estrogen in the blood.

Candida albicans is the most common type of fungus that causes yeast infections. Yeast infections caused by other types of Candida are much more difficult to treat and usually require more aggressive treatments.

Risk factors

Factors that increase the risk of fungal infection include:

• Taking antibiotics. A yeast infection is not uncommon in women who take antibiotics. Broad-spectrum antibiotics kill not only a number of bacteria, but also the normal microflora in the vagina, which can cause yeast overgrowth.
• Increased estrogen levels contribute to the development of yeast infections. This can be both pregnant women and women who use high-dose estrogen birth control pills or if estrogen hormone therapy is being performed.
• Uncontrolled diabetes. Women with poor control and high blood sugar levels are more at risk of developing fungal infections than women who control their blood sugar levels.
• Immune system disorders. Women who are immunosuppressed, such as after corticosteroid therapy or HIV infection, are more at risk of yeast infections.

Prevention

To reduce the risk of vaginal yeast infections, it is recommended to wear underwear that is not too tight with a cotton gusset.

Also recommended:

• Do not use tight tights
• Douche as this flushes out some of the normal bacteria in the vagina that protect against infection.
• Use scented products for women frequently, such as bubble baths, pads, and tampons.
• Extremely hot and whirlpool baths are not recommended
• Do not take antibiotics unnecessarily, such as for colds or other viral infections.
• Avoid prolonged exposure to wet clothing such as swimwear and sportswear.

Diagnosis

To diagnose thrush, a doctor may:

• Ask questions about symptoms and medical history. It is important for the physician to collect information about past vaginal or sexually transmitted infections.
• Perform a gynecological examination. The doctor will examine the external genitalia to look for signs of a fungal infection. Then the doctor will examine the vagina and cervix using a special speculum.
• Collect vaginal secretions. The doctor may send a sample of vaginal fluid for analysis to determine the type of fungus that caused the yeast infection. Identifying the fungus can help your doctor decide on the appropriate treatment, especially if you have recurrent yeast infections.

Treatment

Treatment for yeast infections depends on the severity and frequency of infections.

For mild to moderate symptoms and infrequent episodes, your doctor may recommend:

• Short term vaginal therapy. Taking antifungal medications for three to seven days usually clears up the yeast infection. Antifungal drugs, in the form of creams, ointments, tablets and suppositories, include miconazole (monistat 3) and terconazole. Some of these medicines can be purchased without a prescription, while others are available by prescription only.
• Single oral dose of the drug. Your doctor may prescribe a single oral dose of fluconazole (Diflucan). But taking such drugs is contraindicated during pregnancy.