Genital candidiasis

Overview
Candidiasis is a common fungal infection that occurs when there is overgrowth of the fungus called Candida. Candida is always present in the body in small amounts. However, when an imbalance occurs, such as when the normal acidity of the vagina changes or when hormonal balance changes, Candida can multiply. When that happens, symptoms of candidiasis appear.

Also known as:

Yeast infection or VVC

Epidemiology and Demographics
Nearly 75% of all adult women have had at least one genital "yeast infection" in their lifetime. On rare occasions, men may also experience genital candidiasis. VVC occurs more frequently and more severely in people with weakened immune systems.

Fourth most common cause of nosocomial bloodstream infections. Incidence is 8 cases per 100,000 in the general population. Higher incidence among neonates and African-Americans. OPC used to be a common opportunistic infection in HIV-infected persons (prior to the introduction of highly active antiretroviral therapy [HAART]).

Mortality rate is almost 50% with bloodstream and disseminated infection.

Risk Factors
Invasive disease occurs in critically ill patients in intensive-care units, in persons with severe granulocytopenia, and in hematopoietic stem cell and organ transplant recipients. OPC can be associated with HIV infection. VVC is often associated with pregnancy, diabetes mellitus, and antibiotic therapy.

There are some conditions that may put a woman at risk for genital candidiasis:


 * Pregnancy
 * Diabetes mellitus
 * Use of broad-spectrum antibiotics
 * Use of corticosteroid medications

Pathophysiology & Etiology
Candida albicans and C. glabrata. Less commonly, C.tropicalis, C. parapsilosis, and C. krusei. Rarely, other Candida species.

Most cases of Candida infection are caused by the person’s own Candida organisms. Candida yeasts usually live in the mouth, gastrointestinal tract, and vagina without causing symptoms. Symptoms develop only when Candida becomes overgrown in these sites. Rarely, Candida can be passed from person to person, such as through sexual intercourse.

Most infections are endogenous in origin, but organisms can be transmitted on the hands of care givers.

Diagnosis
The symptoms of genital candidiasis are similar to those of many other genital infections. Making a diagnosis usually requires laboratory testing of a genital swab taken from the affected area by a physician.

Differential Diagnosis
How can someone tell the difference between genital candidiasis/VVC and a urinary tract infection?

Because VVC and urinary tract infections share similar symptoms, such as a burning sensation when urinating, it is important to see a doctor and obtain laboratory testing to determine the cause of the symptoms and to treat effectively.

Risk Stratification and Prognosis
What will happen if a person does not seek treatment for genital candidiasis/VVC?

Symptoms, which may be very uncomfortable, may persist. There is a chance that the infection may be passed between sex partners.

Treatment
Antifungal drugs which are taken orally, applied directly to the affected area, or used vaginally are the drugs of choice for vaginal yeast infections. Although these drugs usually work to cure the infection (80%-90% success rate), infections that do not respond to treatment are becoming more common, especially in HIV-infected women receiving long-term antifungal therapy. Prolonged and frequent use of these treatments can lessen their effectiveness.

Are over-the-counter (OTC) treatments for genital candidiasis/VVC safe to use?

Over-the-counter treatments for VVC are becoming more available. As a result more women are diagnosing themselves with VVC and using one of a family of drugs called "azoles" for therapy. However, misdiagnosis is common, and studies have shown that as many as two-thirds of all OTC drugs sold to treat VVC were used by women without the disease. Using these drugs when they are not needed may lead to a resistant infection. Resistant infections are very difficult to treat with the currently available medications for VVC.

Can Candida infections become resistant to treatment?

Overuse of these antifungal medications can increase the chance that they will eventually not work (the fungus develops resistance to medications). Therefore, it is important to be sure of the diagnosis before treating with over-the-counter or other antifungal medications.

Acknowledgements
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.

List of contributors:

Pilar Almonacid