Candidiasis is a fungal disease that mainly affects the skin and mucous membranes, less often internal organs. There are candidiasis of the respiratory, digestive, and genitourinary systems. With a sharp weakening of immunity, generalized candidiasis (candidiasis sepsis) may develop. Genitourinary disease in men is manifested by inflammation of the penis (redness, swelling, greyish coating and erosions, itching, burning and pain in the area of the penis head). Candidiasis urethritis and cystitis are possible. In women, there is a lesion of the external genitalia and vagina. Without timely treatment, disease takes a chronic recurrent course.
Candidiasis is a fungal disease that mainly affects the skin and mucous membranes, less often internal organs. There are candidiasis of the respiratory, digestive, and genitourinary systems. With a sharp weakening of immunity, generalized candidiasis (candidiasis sepsis) may develop. Genitourinary candidiasis in men is manifested by inflammation of the penis (redness, swelling, greyish coating and erosions, itching, burning and pain in the area of the penis head). Candidiasis urethritis and cystitis are possible. In women, there is a lesion of the external genitalia and vagina. Without timely treatment, disease takes a chronic recurrent course.
Urogenital candidiasis is caused by yeast-like fungi of the genus Candida, representatives of the normal microflora of the mucous membranes of the genitals. The development occurs as a result of intensive reproduction of Candida fungi and their violation of the natural balance of the environment of the genitourinary tract. The development is largely facilitated by a general decrease in the body’s resistance.
Genitourinary form is not a life-threatening disease, but it is extremely unpleasant with its manifestations, leading to disorders in the intimate and psycho-emotional spheres. In addition, the presence may indicate a severe concomitant pathology (diabetes mellitus, HIV infection, etc.).
Disease of the genital organs, or the so-called thrush, affects the mucous membranes of the urogenital tract of men and women, being essentially a sexual infection. Often, thrush is accompanied by other sexually transmitted diseases: chlamydia, gonorrhea, trichomoniasis, etc.
Acute and subacute course lasts no more than 2 months. During this period, edema, hyperemia, discharge from the genital tract and other inflammatory symptoms are pronounced. Chronic forms are characterized by a duration of more than 2 months. Foci of dryness, hyperpigmentation, infiltration, and tissue atrophy develop on the mucous membranes.
Recently, atypical, erased and resistant to treatment forms of genitourinary form have become frequent.
Development of genital candidiasis
According to studies conducted in the field of venereology, the following factors most often contribute to the development of genital form:
- taking antibacterial and a number of hormonal medications;
- candidiasis (dysbiosis) of the intestine;
- diabetes mellitus;
- HIV and other infections that suppress the immune system;
- excessive douching;
- wearing synthetic and tight underwear;
- long-term adverse effects of physical factors (work in warm, humid rooms, etc.).
Manifestations of candidiasis in women
Genitourinary candidiasis is more common among women. About 75% of women have experienced vulvovaginal candidiasis at least once in their lives, and half of them had a recurrent disease. In women, disease of the genitourinary tract is characterized by lesions of the mucous membranes of the vulva and vagina, less often – the cervix, urethra and bladder.
Candidiasis vulvitis and vulvovaginitis, which does not affect the urinary tract, have the following manifestations:
- abundant, milky-white color and curd-like consistency of vaginal discharge with an unpleasant odor;
- sensation of irritation, itching or burning or in the vulva area, which increases after urination, during sleep or after taking a bath;
- soreness of sexual intercourse, increased symptoms of irritation and characteristic unpleasant odor after sexual intercourse.
With candidiasis vulvitis, yeast-like fungi affect the area of the external genitalia: the clitoris, labia minora and labia majora, the vestibule of the vagina. Vulvar candidiasis can occur in typical and atypical clinical forms:
Typical forms of vulvar candidiasis include:
- catarrhal-membranous vulvitis of acute and subacute course;
- catarrhal chronic vulvitis.
Among the atypical forms are:
- leukoplakievid chronic vulvitis;
- kraurosis-like chronic vulvitis;
- asymptomatic pruriginous chronic vulvitis;
Mixed variants of acute fungal infection are also often found: candidiasis – bacterial, candidiasis – chlamydia, candidiasis – gonorrhea, candidiasis – trichomonas vulvitis.
The course of typical forms of vulvar candidiasis is characterized by burning and itching, the intensity of which increases before menstruation and decreases or disappears during menstrual and postmenstrual periods.
The mucous membranes of the vulva affected by candidiasis are hyperemic, have a purplish-bluish hue. Small-point bubbles are visible on the mucous membranes, which, when opened, form extensive erosions. The labia minora are covered with layers in the form of white curd films.
In the chronic form of vulvar form, there is stagnant hyperemia and infiltration of tissues, their thickening and increased dryness.
The atypical course of vulvar form is rare and occurs in a chronic form.
From the mucous membranes of the vulva, disease can spread to the inguinal-femoral folds and the perianal area. Such manifestations are usually observed in chronic candidiasis in patients with myxedema, diabetes mellitus, ovarian hypofunction.
Candidiasis vaginitis is characterized by the spread of fungal lesions on the mucous membranes of the vagina and often the vaginal part of the cervix.
Vaginal form occurs in four main forms:
- candidiasis catarrhal-exudative-membranous vaginitis of acute and subacute course;
- mixed candidiasis-bacterial catarrhal-exudative vaginitis of acute and subacute course;
- candidiasis catarrhal subacute and chronic vaginitis;
- asymptomatic candidiasis chronic vaginitis.
With vaginal candidiasis, the mucous membranes are vividly hyperemic, covered with a creamy or friable crumbly coating. The walls and arches of the vagina, as well as the vaginal part of the cervix, are eroded. The discharge is abundant, curd-like or creamy consistency, sometimes foamy and even purulent in nature with an unpleasant odor. Subjectively, patients note moderate soreness, burning and itching in the vagina.
Candidiasis endocervicitis does not occur independently, but develops only in connection with vaginal candidiasis.
As a result of vaginal form, a fungal infection penetrates through the external pharynx into the cervical canal in an ascending way. Often the cause of the development of candidiasis endocervicitis is the defective function of the ovaries. In the typical course of cervical candidiasis, white crumbly lumps or white thick mucus are released from the cervical canal. Outside, the surface of the cervix is covered with whitish films. The erased form of cervical candidiasis is characterized by a scanty lactic-mucous discharge.
Relatively rare manifestations of genitourinary form in women are candidal urethritis and cystitis. Acute candidal urethritis is characterized by constant dull pains in the lower abdomen and dysuric disorders: cuts, burning, frequent and painful urge to urinate. On examination, there is swelling and hyperemia of the urethral sponges, curd lumps at the external opening of the urethra.
Acute cystitis is manifested by soreness during urination and frequent false urges.
Chronic candidal urethritis and cystitis occur without exacerbations with or without erased symptoms.
Manifestations of candidiasis in men
Genitourinary candidiasis in men is more often manifested in the form of balanitis – inflammation of the glans penis or postitis – inflammation of the inner leaf of the foreskin, or in combination.
Candidiasis balanoposthitis refers to sexually transmitted infections. Its growth is associated with the prevalence of genitourinary candidiasis in women due to the use of hormonal contraceptives, antibacterial and antitrichomonas agents.
The clinical picture depends on the form of its course: membranous, erosive or erythematous-pustular. Subjectively, itching and burning of the glans penis is usually noted. The skin in the area of the head of the penis, the coronal furrow, as well as the inner leaf of the foreskin are hyperemic, swollen and inflamed, covered with a whitish-grayish coating. Infiltration of the foreskin makes it difficult to expose the head. The glans penis can erode and get wet, which facilitates the attachment of a secondary purulent infection. With candidiasis balanoposthitis, there are no symptoms of urination disorder.
The chronic course can be complicated by phimosis due to gradual scarring of the foreskin. Other complications include lymphadenitis, lymphangitis, erysipelas of the penis, candidagranulomas, warty growths, penile carcinoma.
The urethra in men is affected less often, and usually candidiasis urethritis occurs in a subacute form. The incubation period is from 2 weeks to 2 months. This disease of the urethra is accompanied by a slight itching and burning sensation, usually scanty, mucous-watery, less often – abundant and purulent discharge from the urethra. During urethroscopic examination, a whitish plaque is observed in the form of a mucous membrane of the urethra. The removal of plaque is accompanied by the exposure of edematous and sharply hyperemic mucous membrane of the urethra.
Complications of urethral form are often prostatitis, cystitis, epididymitis.
Generalized form of candidiasis
In particularly unfavorable cases, the pathological process can capture many organs with the development of a generalized form of candidiasis. Risk factors in the development of generalization of candidiasis are prematurity, the use of glucocorticoids and antibiotics, artificial nutrition, chemotherapy, drug addiction, surgical operations and the postoperative period, etc. Generalized form occurs with severe fever, reactions from the central nervous system, disorders of the gastrointestinal tract, changes in peripheral blood parameters (leukocytosis, neutrophilosis with a shift to the left), homeostasis disorders.
When symptoms of candidiasis occur, men usually seek help from a urologist, and women come to a gynecologist’s consultation. Diagnosis of genitourinary candidiasis is carried out on the basis of complaints and examination of the mucous membranes of the genitals. The diagnosis of candidiasis is confirmed by the examination of the separated vagina or penis by light microscopy, backpossing and determination of the sensitivity of the isolated Candida varieties to antifungal drugs.
Consultation of a venereologist is necessary for the conduct of differential diagnosis with trichomoniasis, gonorrhea, gardnerellosis, other urogenital infections and the exclusion of concomitant STIs.
With disease of the genitals, it is necessary to exclude the presence of chronic diseases of the body, to assess the state of immunity.
The diagnosis does not require the use of high-precision laboratory techniques, such as PIF or PCR, which detect even single pathogens. The criterion for the diagnosis of the genitourinary organs is the identification of the fact of intensive reproduction of fungal pathogens.
For the treatment of genitourinary form, both local and general measures are carried out. The choice of therapy method is determined by the severity of the course. Mild forms of genital form are usually treated with the use of local drugs, while severe forms involve the additional use of general-acting drugs.
Local therapy is carried out with vaginal candles and tablets, ointments containing antifungal drugs: nystatin, clotrimazole, pimafucin, miconazole, ketoconazole.
Drugs of general action for the treatment are taken orally. For this purpose, fluconazole and itraconazole are prescribed.
The side effects of most of these drugs for the treatment is the suppression of the normal microflora of the genitals, especially lactobacilli, which normally exclude the growth of pathogenic microorganisms. To restore the normal balance of the microflora of the genitals, after a course of antifungal therapy, eubiotics are prescribed, including lactobacilli, or injections of a drug containing inactivated variants of lactobacilli.
Since candidiasis affects not only the genitals, but also the intestines, B vitamins are used in its treatment, the synthesis of which is disrupted by intestinal dysbiosis. The appointment of multivitamins is also justified in candidiasis.
Simultaneous treatment is carried out by all sexual partners of the patient.