What is Candidiasis?
Candidiasis is often known to many females as yeast infection. Candidiasis is the infection if the vulva, vagina, prepuce and glans penis by the organism candida albicans in 80-92% of the cases. Sometimes other candida species, torulopsis species as well as other yeasts species may be the cause of candidiasis. It is not generally classified as Sexually transmitted disease although male partner may get symptoms of the infection after having sex with an infected female partner. 40% of pregnant women and 20% of non-pregnant may be carriers of candida albicans and they may not have any symptoms at all.
Risk factors for candidiasis
1.Patients with diabetes mellitus are more susceptible to candida infection due to the patient’s lower immunity.
2.Long term oral antibiotics will predispose patients to have overgrowth of candida albicans
3.Steroids and other immunosuppressive drugs consumptions decrease patient’s immunity and predispose patient to infection
4.Oral contraceptives have also been associated with an increased risk of candidiasis.
Clinical symptoms and signs of Candidiasis
Female patients most of the time will complain of itch over the vulval area and also a thick curdy white discharge. Other non-specific symptoms include dyspareunia (pain during sexual intercourse), dysuria (pain upon urination), vague soreness and burning sensation over the vulva.
Male patients may have contracted the candida albicans from their female partners. Some may have symptoms like penile itch, a penile rash (balanitis) and sometimes mild swelling post sexual intercourse.
On examination of the genitalia, there may be red rash on the vaginal vulva and at the glans penis. There may also be fissures, satellite lesions (on the perineum, inner thighs and on labia majora) and presence of the curdy discharge in females.
Laboratory tests of confirmation
1.Vaginal PH ranges from 4-4.5 in patients with candidiasis unlike bacteria vaginosis that tend to be more alkaline.
2.Gram stain or wet mount (with 10% potassium hydroxide or saline) on the swabs from the vaginal wall/vulva or the penis prepuce will reveal budding yeast cells and pseudohyphae (sometimes described as spaghetti and meatball picture).
3.Culture on the sabouraud media to identify the organism
Diagnosis of Candidiasis
When there are symptoms and signs of vulvo-vaginitis (inflammation of the vulva and vagina) or balano-posthitis (inflammation of foreskin and head of penis) PLUS the demonstration of the pseudohyphae/yeasts found on the gram stain/wet mount or a positive culture, diagnosis of candidiasis is then made.
Treatment regimens for Candidiasis
Patients with no symptoms but tested positive for candida albicans do not require treatment as they are most likely carriers of the candida species. For patients with symptoms, treatment is necessary.
They can be treated with Clotrimazole pessary 500 mg single dose or Miconazole vaginal tablet 200 mg daily for 3 days or with Econazole nitrate ovule 150 mg intra-vaginally for 3 nights or Nystatin pessary 100,000 U daily for 1 week or Fluconazole 150 mg orally once. Do note that oil based creams or pessaries might weaken the latex in condoms.
For guys with balano-posthitis, topical anti-fungal creams twice daily for 1 week will be able to eradicate the infection.
For pregnant women with candidiasis, oral medicine is not recommended as it is not safe. Only topical treatment is allowed.
Treatment Regimes for recurrent Candidiasis
Recurrent candidiasis is defined as 4 or more episodes of vulvo-vaginal candidiasis presenting with symptoms. Predisposing risk factors like diabetes, immunosuppressant drugs and steroids usage must be excluded.
Systemic treatment is required for recurrent candidiasis. Induction treatments include oral ketoconazole 200 mg daily for 10 to 14 days or oral Itraconazole 100 mg twice daily for 1-3 days or fluconazole 150 mg one single dose.
This is then followed by a maintenance regime comprising of oral fluconazole 100 mg once a week for 6 months or oral Itraconazole 400 mg once a month for 6 months or Clotrimazole 500 mg pessary once a week for
When patients are on anti-fungal drugs, the liver function test must be monitored routinely. There may also be a reduced efficacy in contraceptives if used together.
In general, once treated there is no need to follow up for test of cure. No recommendations so far to support screening of females or partners for candida albicans.
Prevention of Candidiasis
In general try to avoid tight fitting clothing, local irritants such as perfumed products and also scanted panty liners.