Vaginal candidiasis, also called vulvovaginitis candidiasis is a fungal infection caused by the fungus candida species, usually the Candida albicans. Other forms of Candida, such as Candida glabrata, can also cause vulvovaginitis, but are much less common.
Vaginal candidiasis is an extremely common form of vaginitis, losing in effect only for bacterial vaginosis caused, in most cases the bacterium Gardnerella. About 1/3 of cases of vaginal discharge are caused by infectious candid.
The Candida albicans is a common fungus vaginal flora, present in 1 to 5 women. Their presence itself poses no danger to healthy people. Candidiasis disease arises only when the population of candid colonizing the skin becomes too high. This increase can be stimulated by the use of antibiotics, contraceptives with high doses of hormones, diabetes, immune system disorders, use of glucocorticoids, among others. So having Candida albicans colonizing the genital area does not necessarily mean that a woman will candidiasis disease.
The Candida albicans can even be transmitted sexually in some cases, but in most cases the fungus comes from the person himself, usually from the gastrointestinal tract. Virgins or without sex for years may have episodes of vaginal candidiasis, ringworm why this is not considered a sexually transmitted disease.
The treatment of candidiasis this only indicated in women with vaginitis complaints, such as itching or vaginal burning, whitish discharge or pain in the vaginal area at the time of urinating or during sex. Asymptomatic women do not need to take medication for candidiasis. The same goes for asymptomatic partners.
For treatment purposes, the vaginal candidiasis is divided into two groups:
Candidiasis uncomplicated.
Complicated candidiasis.
1) Treatment of uncomplicated candidiasis
To be considered an uncomplicated vaginal candidiasis, the infection must have the following characteristics:
Be sporadic, occurring in up to 3 episodes per year
Not cause serious symptoms
Be caused by Candida albicans
Arise in healthy, non - pregnant women
For patients who fit this less severe form of infection, there are several options remedies and ointments for vaginal candidiasis.
In uncomplicated as candidiasis, both the tablets orally, for the intravaginal topical treatments, such as ointments, creams or ovules are highly effective with a cure rate above 90%. As effectiveness is similar choosing the most appropriate treatment, be it orally or intravaginally, should be determined in conjunction with the patient in accordance with the advantages and disadvantages of each form.
The administration of drugs by oral candidiasis often more convenient, however, the rate of side effects such as nausea, diarrhea or headache is somewhat more common. The oral medications also take about 24 to 48 more hours to fully alleviate the symptoms of vulvovaginitis, when compared to ointments or vaginal ovules.
The Fluconazole tablet, 150 mg single dose, is the most widely used treatment for vaginal candidiasis. One option is less convenient dosage itraconazole 200 mg daily for 3 days.
Regarding treatments vaginally, the range of options is much higher. Some of the listed schemes are:
Clotrimazole for candidiasis:
Clotrimazole cream 1% - 1 application (5 g) at night for 6 to 7 days.
Clotrimazole cream 2% - 1 application (5 g) at night for 3 days.
Clotrimazole vaginal tablet 500 mg - 1 tablet intravaginal at night in a single dose.
Clotrimazole vaginal tablet 100 mg - 1 tablet intravaginal at night for 6 days.
Miconazole for candidiasis:
Miconazole cream 2% - 1 application (5 g) evening for 7 to 14 days.
200 mg miconazole egg - 1 intravaginal egg night for 3 days.
Nystatin for candidiasis:
Nystatin cream 100,000 IU - 1 application (4 g) at night for 14 days.
Terconazole for candidiasis:
Terconazole cream 0.8% - 1 application (5 g) at night for 3 to 5 days.
80 mg egg terconazole - 1 intravaginal egg night for 3 days.
2) Treatment of complicated candidiasis
To be considered a complicated vaginal candidiasis, the infection must have one or more of the following features:
Being applicant, more than four episodes a year.
Induce very severe symptoms.
Be caused by a Candida other than Candida albicans , for example, Candida glabrata.
Pregnant attack, patients with poorly controlled diabetes or any disease causing immunosuppression.
a) Recurrent vaginal candidiasis
The treatment of recurrent cases of candidiasis can be difficult, time consuming and frustrating. Treatment should be based on three pillars: removal of predisposing factors (eg better control diabetes, use weaker pills or other contraceptive methods, avoid unnecessary use of antibiotics, avoid vaginal douches, etc.), eliminate the current infection and prevent recurrence.
The best treatment for recurrent candidiasis is fluconazole 150 mg orally, three doses with an interval of 72 hours between each. At the end of this scheme begins preventive treatment with Fluconazole 150 mg, 1 tablet orally, 1 time per week for 6 months.
An alternative for those who do not wish to oral treatment is any use of the intravaginal schemes described in the previous section for 14 days, followed by 500 mg clotrimazole vaginal tablet, 1 tablet intravaginally 1 time per week for 6 months.
b) Vaginal candidiasis with severe symptoms
In case of non-recurrent candidiasis, but with very severe symptoms, the treatment can be done with Fluconazole 150 mg orally, three doses with an interval of 72 hours between each.
An alternative for those who do not want the oral treatment is to use any of the intravaginal schemes described in the previous section for 10 to 14 days.
c) Non-albicans Candidiasis
When the type of candida responsible for IPV is not Candida albicans , treatment should be directed according isolated candida. Research the type of candida is usually done in cases of recurrent infection or difficult to eliminate.
Candida glabrata: Boric acid, vaginal capsule 600 mg 1 time per day for 14 days. Candida krusei: clotrimazole, miconazole or terconazole intravaginal for 7 to 14 days.
d) Candidiasis in pregnancy
In pregnant, treatment should be done intravaginally. The clotrimazole and miconazole for 7 days are the most used drugs.
