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, chronic and prone to relapse.

Epidemiology

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

When examining vaginal discharge, the most frequently isolated species is C. albicans (about 90%), as well as other species of this genus: 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 pathogen of hospital-acquired infections.

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

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Causes urogenital candidiasis

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

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Risk factors

Yeast-like fungi of the genus Candida are widespread in nature. The disease in humans occurs due to hormonal imbalance, defects in general and local immunity, disturbances in the normal microbiocenosis of cavities due to an overdose of broad-spectrum antibiotics, while the causative agent of the disease is fungi found in the body itself.

Risk factors for recurrent urogenital candidiasis

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

Most women with recurrent candidiasis have no obvious predisposing factors.

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Symptoms urogenital candidiasis

The following symptoms of urogenital candidiasis are distinguished:

• Intense irritation and itching in the vagina.
• Typical white curdy discharge.
• Burning in the area of the external genitalia when urinating and pain during sexual intercourse.
• In chronically recurring diseases, an exacerbation is often observed before the onset of menstruation.
• In newborns, clinical manifestations of the disease develop immediately after birth (in case of congenital candidiasis) or at a later stage in the form of local lesions of the skin and mucous membranes or severe visceral lesions up to sepsis.

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

• increased amount of vaginal discharge;
• unusually white discharge with “milky” plaques;
• itching, burning or irritation in the external genital area;
• increased vulvovaginal itching in warm conditions (during sleep or after a bath);
• increased sensitivity of the mucous membrane to water and urine;
• increased itching and pain after sexual intercourse;
• an unpleasant odor that intensifies after sexual intercourse.

Forms

A distinction is made between acute, chronic (recurrent) urogenital candidiasis, candidiasis not caused by C. albicans, and candidiasis carriage.

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Complications and consequences

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

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Diagnostics urogenital candidiasis

Laboratory research methods:

• The microscopic method is preferable for diagnosing urogenital candidiasis, since 20% of healthy women have Candida in their vagina that grows when cultured, which would provide grounds for an unfounded diagnosis of vaginal candidiasis. Unstained preparations, as well as preparations stained by Gram, Romanovsky-Giemsa, and methylene blue are used for microscopy. The diagnosis is based on the detection of fungal elements: single budding cells, pseudomycelium, and other morphological structures (blastoconidia, pseudohyphae).
• The cultural method is necessary in the case of chronic recurrent disease, for the identification of yeast-like fungi (especially for the detection of species not related to C. albicans), when studying the effect of medicinal antifungal drugs, and in the case of atypical disease, when other possible pathogens are excluded.
• Molecular biological methods (PCR) - detection of DNA of a certain type of yeast-like fungi (for example, C. albicans). Highly sensitive and specific. Have limitations due to the possible presence of yeast-like fungi in the norm.
• Direct immunofluorescence (DIF) methods have limitations due to the large number of false positive results.
• Serological methods are not used due to the low immunogenicity of yeast-like fungi.

Physical examination

In the vagina and ectocervix - round, separate or merging whitish-cheesy plaques, under which there is a hyperemic mucous membrane. Possible damage to the labia majora and minora, clitoris, urethra.

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Screening

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

Treatment urogenital candidiasis

In case of persistent and recurrent urogenital candidiasis, it is necessary to undergo examination and treatment by related specialists (possibly a gastroenterologist, endocrinologist, oncologist, etc.)

The doctor’s course of action when urogenital candidiasis is diagnosed:

1. Patient's message about diagnosis.
2. Providing information on behavior during treatment.
3. Collection of sexual anamnesis.
4. Predisposing and supporting factors are identified and measures for their elimination are discussed, especially in chronic relapsing processes.
5. The doctor discusses with the patient the possibility and necessity of testing for other STIs. Vaccination against hepatitis B is recommended.
6. If there are no results from treatment, the following possible reasons should be considered:
   • false positive test result;
   • non-compliance with treatment regimen, inadequate therapy;
   • vulvovaginitis is caused by yeast-like fungi other than C. albicans;
   • the presence of other predisposing and supporting factors.

Patient education

Patient education should be aimed at implementing measures to prevent sexually transmitted infections and to prevent infection of sexual partners.

Prevention

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

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Forecast

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

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