VAGINITIS (YEAST)
Vulvovaginal candidiasis (VVC), sometimes referred to as candidal vaginitis, monilial infection, or vaginal yeast infection, is a common cause of vaginal irritation. It has been estimated that approximately 75 percent of all women will experience at least one episode of VVC during their lifetime. VVC is caused by an overabundance or overgrowth of yeast cells (primarily Candida albicans) that normally colonize in the vagina. Several factors are associated with increased rates of VVC in women, including pregnancy, uncontrolled diabetes mellitus, and the use of oral contraceptives or antibiotics. Other factors that may increase the incidence of VVC include the use of douches, perfumed feminine hygiene sprays, topical antimicrobial agents, and tight, poorly ventilated clothing and underwear. There is no direct evidence that VVC is transmitted by sexual intercourse.Symptoms. The most frequent symptoms of VVC in women are itching, burning, and irritation of the vagina. Painful urination and/or intercourse are common. Abnormal vaginal discharge is not always present and may be minimal. The discharge is typically described as cottage-cheese-like in nature, although it may vary from watery to thick in consistency. Most male partners of women with VVC do not experience any symptoms of the infection. However, a transient rash and burning sensation of the penis have been reported after intercourse if condoms were not used. These symptoms are usually self-limiting.
Diagnosis. Because few specific signs and symptoms are usually present, this condition cannot be diagnosed by the patient's history and physical examination. VVC is usually diagnosed through microscopic examination of vaginal secretions for evidence of yeast forms.
Treatment. Various antifungal vaginal creams are available to treat VVC. Some antifungal creams (miconazole and clotrimazole) are available over the counter for use in the vagina; however, because BV, trichomoniasis, and VVC are difficult to distinguish on the basis of symptoms alone, a woman with vaginal symptoms should see a physician for an accurate diagnosis before using these products.
Other products available over the counter contain antihistamines or topical anesthetics that only mask the symptoms and do not treat the underlying problem. Women who have chronic or recurring VVC may need to be treated for extended periods of time and may be given oral antifungal drugs.
They should work with their physicians to determine possible underlying causes of their chronic yeast infections. Because there is no evidence for sexual transmission of VVC, routine treatment of male partners is unlikely to reduce recurrence.