Кандидозний вагініт

Vulvovaginal pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common, as is a thick, white, curd–like vaginal discharge that adheres to the vaginal walls. Symptoms and signs increase the week before menses. Erythema, edema, and excoriation are common.

Women with vulvovaginal candidiasis may have no discharge, a scanty white discharge, or the typical curd-like discharge.

Infection in sex partners is rare.

Recurrences after treatment may occur if there is resistance to antifungals or if a patient has non- Candida albicans species like Candida glabrata.

• Pelvic examination

• Vaginal pH and microscopy

• Culture, if vaginitis is persistent or recurrent

Hyphae and Spores in Candidal Vaginitis

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By permission of the publisher. From Sobel JD. In Atlas of Infectious Diseases: Fungal Infections. Edited by GL Mandell and RD Diamond. Philadelphia, Current Medicine, 2000. Also from Sobel JD. In Atlas of Infectious Diseases. Edited by GL Mandell and MF Rein. Philadelphia, Current Medicine, 1996.

Criteria for diagnosing candidal vaginitis include

• Typical discharge (a thick, white, curd-like vaginal discharge)

• Vaginal pH is < 4.5

• Budding yeast, pseudohyphae, or mycelia visible on a wet mount, especially with potassium hydroxide (KOH)

If symptoms suggest candidal vaginitis but signs (including vulvar irritation) are absent and microscopy does not detect fungal elements, fungal culture is done. Women with frequent recurrences require culture to confirm the diagnosis and to rule out non-albicans Candida.

Also, some diagnostic tests are commercially available for clinical use (1).

• Antifungal medications (fluconazole in a single oral dose preferred)

• Avoidance of excess moisture accumulation

Keeping the vulva dry and wearing loose, absorbent cotton clothing that allows air to circulate can reduce vulvar moisture and fungal growth.

Topical or oral medications are highly effective for candidal vaginitis (see table Medications for Candidal Vaginitis). Adherence to treatment is better when a one-dose oral regimen of fluconazole 150 mg is used.

New oral antifungal medications to treat candidal vaginitis include ibrexafungerp and oteseconazole. Clinical use of these varies. Some experts advise treatment with these antifungals in symptomatic patients who fail topical azoles and/or oral fluconazole as documented by saline microscopy or fungal culture.

Topical butoconazole, clotrimazole, miconazole, and tioconazole are available over the counter. However, patients should be warned that topical creams and ointments containing mineral oil or vegetable oil weaken latex-based condoms and diaphragms.

If symptoms persist or worsen during topical therapy, hypersensitivity to topical antifungals should be considered.

Patients who have frequent recurrences (at least 4 documented episodes of candida vaginitis in the previous 12 months) require long-term suppression with oral medications (fluconazole 150 mg weekly to monthly or ketoconazole 100 mg once a day for 6 months) (1). Suppression is effective only while the medications are being taken. These medications may be contraindicated in patients with liver disorders. Patients taking ketoconazole should be monitored periodically with liver tests.