Urogenital Candidiasis

Urogenital candidiasis is a fungal disease of the mucous membranes of the urogenital organs, caused by yeast-like fungi of the genus Candida. Urogenital candidiasis is widespread, occurs chronically and is prone to relapse.

Epidemiology

Candidiasis of the vaginal mucosa (candidal vaginitis) is a common disease in women of reproductive age. About 70% of all women in their lives at least once suffered this disease. 40-50% of women have repeated episodes of the disease, and 5% develop chronic recurrent candidiasis - an extremely unpleasant course of the disease. Along with a clinically pronounced disease, there is an asymptomatic colonization of the vagina by yeast-like fungi.

The species C. Albicans (about 90%), as well as other species of this genus, are most often isolated from the vaginal discharge : C. Tropicalis, C. Kefir, C. Krusei, C. Lusitaniae, C. Parapsilosis, C. Guilliermondii, C glabrata, C. Lambica. In recent years, C. Glabrata has been described as a dangerous causative agent of nosocomial infections.

Candidiasis is not considered an STI, but may indicate changes in the immune and / or hormonal status.

[1], [2], [3], [4], [5], [6]

Causes of the urogenital candidiasis

The causative agent of urogenital candidiasis is most often Candida albicans, the most pathogenic of yeast-like fungi of this genus.

[7], [8], [9], [10]

Risk factors

Yeast-like fungi of the genus Candida are widely distributed in nature. Disease in humans occurs with hormonal imbalance, defects in general and local immunity, violations of normal microbiocenosis of cavities due to overdose of antibiotics of a wide spectrum of action, while the causative agent of the disease are mushrooms that are in the body itself.

Risk factors for recurrent urogenital candidiasis

• Uncontrolled diabetes.
• Immunosuppression.
• Glucocorticoid therapy.
• HIV infection.
• Antibacterial therapy.

Most women with recurrent candidiasis do not have obvious predisposing factors.

[11], [12], [13], [14], [15]

Symptoms of the urogenital candidiasis

The following symptoms of urogenital candidiasis are distinguished:

• Intensively pronounced irritation and itching in the vagina.
• Typical white curdled discharge.
• Burning in the area of the external genital organs with urination and soreness in sexual contact.
• With a chronically recurrent disease, often an exacerbation occurs before the onset of menstruation.
• In newborns, the clinical manifestations of the disease develop immediately after birth (with congenital candidiasis) or later in the form of local lesions of the skin and mucous membranes or severe visceral lesions up to sepsis.

In women, most often the urogenital candidiasis process is localized in the area of the external genitalia and vagina. Candidiasis vulvitis and vulvovaginitis without urinary tract infection are characterized by the following symptoms:

• increase in the amount of vaginal discharge;
• unusually white with "milky" plaques color of detachable;
• itching, burning or irritation in the area of the external genitalia;
• increased vulvovaginal itching in the warmth (during sleep or after a bath);
• hypersensitivity of the mucous membrane to water and urine;
• increased itching and pain after sexual intercourse;
• an unpleasant odor that increases after sexual intercourse.

Forms

There are acute, chronic (recurrent) urogenital candidiasis, candidiasis caused not by C. Albicans, but also candidacy.

[16], [17], [18], [19]

Complications and consequences

The disease can have a prolonged course, possibly from a month to several years. Exacerbations coincide with menstruation or intercurrent diseases.

[20], [21], [22],

Diagnostics of the urogenital candidiasis

Laboratory methods of research:

• The microscopic method is the preferred method for diagnosing urogenital candidiasis, since 20% of healthy women have candidias in the vagina that grow on sowing, which will give rise to an unjustified diagnosis of vaginal candidiasis. For microscopy, unpainted preparations are used, as well as preparations colored according to Gram, according to Romanovsky-Giemsa, methylene blue. The diagnosis is based on the detection of fungal elements: single cells, pseudomycelia, other morphological structures (blastoconidia, pseudohyfy).
• The culture method is necessary for the chronic recurrent course of the disease, for the identification of yeast-like fungi (especially for the identification of species not belonging to C. Albicans), in the study of the action of medicinal antimycotic drugs, in the atypical course of the disease, when other possible pathogens are excluded.
• Molecular biological methods (PCR) - the detection of DNA of a specific type of yeast-like fungi (eg, C. Albicans). Highly sensitive and specific. They have limitations because of the possible presence of yeast-like fungi in the norm.
• Methods of direct immunofluorescence (PIF) have limitations due to a large number of false positive results.
• Serological methods - do not use because of low immunogenicity of yeast-like fungi.

Physical examination

In the vagina and ectocervix - rounded separate or merging whitish-curdled raids, under which is a hyperemic mucosa. Possible defeat of large and small labia, clitoris, urethra.

[23], [24],

Screening

Examination of women with complaints of itching, dyspareunia, curdled discharge from the genital tract.

Treatment of the urogenital candidiasis

With persistent flow and recurrence of urogenital candidiasis, it is necessary to conduct examination and treatment with related specialists (possibly a gastroenterologist, endocrinologist, oncologist, etc.)

The procedure of the doctor with the diagnosis of urogenital candidiasis:

1. The patient is informed of the diagnosis.
2. Presentation of information on behavior during treatment.
3. Gathering of a sexual anamnesis.
4. Identify predisposing and supporting factors and discuss measures for their elimination, especially in a chronic recurrent process.
5. The doctor discusses with the patient the possibility and necessity of testing for other STIs. Vaccination against hepatitis B has been recommended.
6. In the absence of results from treatment, the following possible causes should be considered:
   • false positive result of the study;
   • non-compliance with treatment regimen, inadequate therapy;
   • Vulvovaginitis is caused by yeast-like fungi other than C. Albicans;
   • presence of other predisposing and supporting factors.

Patient education

Training of patients should be aimed at implementing measures for the prevention of sexually transmitted infections to prevent infection of sexual partners.

Prevention

It is important to prevent candidiasis in people who have a combination of several predisposing factors: immunodeficiency, blood disease, neoplasm, condition after severe operations, and after massive treatment with antibiotics, glucocorticoid hormones, cytostatics that received ionizing radiation. Importance is attached to the treatment of intestinal dysbiosis, the detection and treatment of candidiasis in pregnant women, the treatment of people with genital candidiasis and their sexual partners, etc. Prevention should be aimed at strengthening the body's defenses, including adequate nutrition, vitamins.

[25], [26], [27], [28], [29], [30]

Forecast

Urogenital candidiasis has a favorable prognosis, but with inadequate therapy, complications may develop.

[31], [32], [33], [34]