Vaginal thrush is a fungal lesion of the vaginal mucosa. The manifestations are itching and burning in the vulva, abundant curd discharge, pain during urination and sexual intercourse. It is possible to spread a fungal infection in the body and transition to a generalized form, disruption of the normal course of pregnancy and childbirth, infection of the fetus. Diagnosis according to gynecological examination, colposcopy, microscopic and bacteriological smear examination. Treatment is carried out with local and systemic antifungal drugs.
General information
Vaginal thrush is an inflammatory lesion of the vaginal mucosa caused by fungi of the genus Candida. It is characterized by burning and itching in the vagina, white curd secretions. This pathology is also called candidiasis of newborns, most often manifested as candidiasis of the oral cavity. Diagnosis is carried out by detecting the fungus by microscopy and culture examination of vaginal smears. To exclude concomitant STIs, ELISA and PCR studies are conducted. Chronic recurrent disease is an indication for a complete examination of the patient in order to identify those disorders in the body that could cause such a course of vaginal thrush. Treatment is carried out by local and general use of antimycotic drugs.
Yeast-like Candida fungi, which provoke the development of vaginal thrush, are the conditionally pathogenic flora of the vagina of most women and at the same time do not cause any pathological symptoms. Therefore, unlike classical STIs, pathology cannot be 100% attributed to sexually transmitted diseases, although Candida fungi can be transmitted from sexual partners. Clinical gynecology deals with the diagnosis and treatment of candidiasis due to the similarity of its clinical picture with sexual infections and frequent cases of a combination of these diseases.
Causes
Various factors that disrupt the healthy microflora of the vagina lead to the development of this infection. As a result, there is a decrease in the number of beneficial bacteria that normally inhibit the growth of fungal flora, and an intensive reproduction of fungi. The active growth of fungi leads to the manifestation of their pathogenic properties with the appearance of inflammatory changes in the vaginal mucosa, such as colpitis or vaginitis.
Violation of the normal ratio of microorganisms in the vagina with the development of vaginal thrush can be caused by treatment with cytostatics and other immunosuppressors, the use of hormonal contraception, decreased immunity due to somatic diseases (HIV, chronic bronchitis, tonsillitis, chronic pyelonephritis, liver cirrhosis, etc.), hormonal abnormalities (diabetes mellitus, ovarian dysfunction, menopause, hypothyroidism, obesity), anorexia, pregnancy, stressful situations, sudden climate change.
Prolonged or frequent antibiotic therapy, the use of antibacterial drugs without additional administration of probiotics primarily cause intestinal dysbiosis. Since the intestine is a reservoir of Candida fungi, its diseases (dysbiosis, colitis, etc.) lead to the spread of Candida to other organs and, above all, into the vagina with the development of vaginal thrush.
Various local factors can have an adverse effect on the biocenosis of the vagina with the appearance of vaginal thrush: non-compliance with personal hygiene, irregular change of pads and vaginal tampons, the use of local contraceptives, the use of deodorized pads and flavored colored toilet paper, wearing synthetic underwear. Frequent use of antibacterial agents for hygienic purposes (antibacterial soap, intimate gel, vaginal spray) often leads to a decrease in local natural immunity and can provoke the occurrence of vaginal thrush.
In some women, the appearance of vaginal thrush is observed after wearing wet underwear, visiting the pool or swimming in open reservoirs. This is due to the beneficial effect of the humid environment on the vital activity of Candida fungi. Improper nutrition with excessive consumption of sweets can also contribute to the development of vaginal thrush.
Newborns born to mothers with this disease may develop vaginal thrush as a result of infection during the prenatal period or passing through the birth canal. The development in such cases is facilitated by the weakened state of the child’s body due to the birth trauma, premature birth, hemolytic disease, intrauterine hypoxia, suffered asphyxia of the newborn.
Symptoms of vaginal thrush
Disease is manifested by severe burning and itching in the area of the external genitals and vagina. These symptoms are accompanied by the appearance of secretions that have a characteristic white color for candidiasis. For this disease, the heterogeneous consistency of secretions with small lumps resembling cottage cheese grains is typical. The discharge may have a sour smell. Many women suffering from vaginal thrush note an increase in the amount of secretions after sexual intercourse, water procedures, at night. There is often redness of the labia minora, sometimes swelling of the labia minora and labia majora, which can reach the anus. Swelling and inflammatory changes in the vaginal mucosa lead to the fact that during sexual intercourse a woman has pain. Painfulness of urination may be noted.
Quite often there is an erased course of pathology, when its clinical manifestations are poorly expressed or only one of these symptoms is present. Symptoms may spontaneously pass with the appearance of menstrual discharge, since during this period the vaginal environment shifts to the alkaline side, less favorable for fungi. However, vaginal thrush can also acquire a chronic course. Her relapses, as a rule, occur at least 4 times a year and usually occur a week before the start of menstruation. Chronic form is much worse to treat and can lead to complications. It is possible to combine vaginal thrush with other infectious lesions of the vagina (ureaplasmosis, chlamydia, genital herpes, etc.).
The most common manifestation of vaginal thrush in newborns is candidiasis of the gums (gingivitis), soft palate, cheek mucosa (stomatitis) and tongue (glossitis). It is manifested by the appearance of white-coated areas or spots on the mucous membrane. When removing the plaque, a red and inflamed mucosa is exposed under it. A newborn suffering from vaginal thrush is restless, often screams, sucks poorly and may refuse to breastfeed. Less often, disease of newborns manifests itself in the form of candidiasis conjunctivitis. The consequence of intrauterine infection can be fungal-induced pneumonia.
Complications
Chronically occurring form can cause a number of complications. First of all, they are caused by the spread of fungal infection to structures located next to the vagina: the cervix with the development of cervicitis, the urethra with the development of urethritis and the bladder with the development of cystitis. The combination with other STIs with a prolonged recurrent course can lead to the development of infertility in women.
Diagnosis
As a rule, patients with symptoms turn to a gynecologist. The doctor performs an examination on the chair and colposcopy, takes swabs from the mucous membrane of the cervix and vagina. Microscopic examination of smears in vaginal thrush reveals the presence of fungal mycelium in the preparation. This is a quick method of research, but it does not provide accurate information about which kind of fungi caused the disease. To answer this question, a back-sowing smear is carried out on special nutrient media, followed by the study of grown colonies and the determination of the susceptibility of isolated Candida fungi to antimycotic drugs. At the same time, the quantitative characteristics of the identified Candida colonies are taken into account, since their small number is normal for a healthy vaginal microflora.
Clinical observations show that vaginal thrush quite often occurs against the background of other sexual infections and can “mask” their presence. Therefore, if disease is detected, it is advisable to consult an additional venereologist and undergo an examination for STIs. Complex PCR diagnostics is usually used, which, if necessary, can be supplemented with ELISA.
Since the development of vaginal thrush is usually associated with certain disorders occurring in the body, then when it is detected, a full examination of the woman is necessary. This is especially true in cases where vaginal thrush does not respond well to treatment or takes a chronic course. Vaginal thrush is often the first symptom of diabetes mellitus. Therefore, a woman needs to take a blood test for sugar and, if it increases, contact an endocrinologist. Examination by a gastroenterologist is also recommended: analysis for dysbiosis, coprogram, gastroscopy, stomach radiography, ultrasound of the abdominal cavity, irrigoscopy, X-ray examination of the small intestine.
With the development of complications from the urinary tract, it is necessary to consult a urologist, a study of urine and a smear from the urethra, a Zimnitsky test, an ultrasound of the bladder. Differential diagnosis should be carried out with bacterial vaginosis, gonorrhea, genital herpes, trichomoniasis.
Treatment of vaginal thrush
Local treatment can be carried out in the case of its primary occurrence and uncomplicated course. It is carried out by vaginal candles or tablets containing antifungal drugs: miconazole, clotrimazole, isoconazole, natamycin. Treatment of acute vaginal thrush is carried out from 1 day to a week, depending on the prescribed drug. Its efficiency reaches 80-90%. During treatment, it is necessary to carefully observe intimate hygiene and refrain from sexual contact.
It should not be used in the local treatment with wide-spectrum vaginal preparations, which include nystatin. They suppress the beneficial microflora of the vagina and often lead to the development of gardnerellosis. With a mild course of vaginal thrush, local treatment can be replaced with a single dose of fluconazole. The disappearance of the symptoms is not always a sign of cure. After treatment, a repeated examination of the vaginal smear is necessary.
With insufficient effectiveness of local therapy, chronic course of thrush, systemic administration of antimycotic drugs inside is indicated. Most often, fluconazole is used for this purpose. After antifungal therapy, it is necessary to restore healthy vaginal microflora. For this purpose, eubiotics are prescribed. However, their use is advisable only after laboratory-confirmed elimination of candidiasis.
Treatment of chronic form can last several months. It should include therapy of concomitant diseases, correction of intestinal dysbiosis, general restorative agents, exclusion of provoking factors (taking antibiotics, oral contraceptives, etc.). Physiotherapy methods are widely used in the treatment of recurrent vaginal thrush: SMT, magnetotherapy, electrophoresis, laser therapy, darsonvalization.
Treatment of newborns in most cases is carried out by local treatment of the oral cavity with a solution of chlorhexidine or sodium bicarbonate. General antifungal therapy is used only in complicated cases.
Treatment of vaginal thrush in pregnant women
The occurrence of vaginal thrush is observed in more than half of pregnant women. Its treatment requires a comprehensive approach, taking into account the contraindications existing during pregnancy. It is important to identify diseases and pathological conditions that can provoke vaginal thrush. In pregnant women, the treatment is carried out mainly by local means. Most often these are candles with miconazole or clotrimazole. If systemic antifungal therapy in pregnant women is necessary, natamycin may be used, since it does not have an embryotoxic effect.
During pregnancy, it is possible to use folk methods of treating vaginal thrush. These include washing with decoction of oak bark, calendula or soda solution, soda-iodine baths, etc. These methods are weakly effective in terms of a complete cure of vaginal thrush, but they can help relieve its symptoms during pregnancy.
Prevention
Prevention of vaginal thrush includes adequate antibiotic therapy against the background of mandatory prescribing of probiotics; timely and correct treatment of chronic diseases, STIs, hormonal disorders; compliance with intimate hygiene; wearing cotton underwear. It is necessary to avoid the use of hygienic and intravaginal agents that can change the pH of the vagina from the acidic side or cause an imbalance in its microflora. To prevent vaginal thrush from appearing from improper use of tampons and pads, women should remember that they need to be changed every 3-4 hours. Women who have the appearance provoked by a humid environment, it is necessary to wipe themselves thoroughly after bathing, avoid wearing a wet swimsuit, and use a spare dry bathing kit when resting on a pond.
Prevention of vaginal thrush in newborns is facilitated by a complete examination of women during pregnancy planning, earlier detection and treatment in pregnant women.