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Vulvovaginal Candidiasis

Disease Details

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Description: Vulvovaginal candidiasis is a common fungal infection caused by the overgrowth of Candida species, leading to itching, discharge, and irritation of the vulva and vagina.
Type: Vulvovaginal candidiasis is an infection caused by the overgrowth of Candida species, typically Candida albicans. It is not a genetically transmitted disease; rather, it is influenced by factors such as antibiotic use, hormonal changes, and immune system status.
Signs And Symptoms: The symptoms of vaginal thrush include vulval itching, vulval soreness and irritation, pain or discomfort during sexual intercourse (superficial dyspareunia), pain or discomfort during urination (dysuria) and vaginal discharge, which is usually odourless. Although the vaginal discharge associated with yeast infection is often described as thick and lumpy, like paper paste or cottage cheese, it can also be thin and watery, or thick and of uniform texture. In one study, women with vaginal yeast infection were no more likely to describe their discharge as cottage-cheese like than women without.As well as the above symptoms of thrush, vulvovaginal inflammation can also be present. The signs of vulvovaginal inflammation include erythema (redness) of the vagina and vulva, vaginal fissuring (cracked skin), edema (swelling from a build-up of fluid), also in severe cases, satellite lesions (sores in the surrounding area). This is rare, but may indicate the presence of another fungal condition, or the herpes simplex virus (the virus that causes genital herpes).Vaginal candidiasis can very rarely cause congenital candidiasis in newborns.
Prognosis: The prognosis for vulvovaginal candidiasis is generally good with appropriate treatment. Most cases respond well to antifungal medications, whether they are topical or oral. Recurrence is possible, especially in individuals with predisposing factors such as antibiotic use, diabetes, or a weakened immune system. Recurrent cases may require longer treatment duration or maintenance therapy to prevent future episodes.
Onset: Vulvovaginal candidiasis, commonly known as a yeast infection, typically has an acute onset. Symptoms can develop rapidly over a period of hours to days.
Prevalence: Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida species, typically Candida albicans. Around 75% of women will experience at least one episode of VVC in their lifetime, and 40-45% will have two or more episodes. Recurrent VVC, defined as four or more episodes in a year, affects approximately 5-8% of women.
Epidemiology: The number of cases of vaginal yeast infection is not entirely clear because it is not a reportable disease and it is commonly diagnosed clinically without laboratory confirmation.Candidiasis is one of the three most common vaginal infections along with bacterial vaginosis and trichomonas. About 75% of women have at least one infection in their lifetime, 40%–45% will have two or more episodes, and approximately 20% of women get an infection yearly.
Intractability: Vulvovaginal candidiasis, commonly known as a yeast infection, is generally not considered intractable. Most cases can be effectively treated with antifungal medications, which are available in various forms such as creams, ointments, tablets, and suppositories. However, some cases can recur or become chronic, necessitating longer-term or repeated treatment. If symptoms persist despite treatment, it may be necessary to investigate underlying conditions or factors that could be contributing to the persistence of the infection.
Disease Severity: The severity of vulvovaginal candidiasis can vary. It typically manifests as mild to moderate in most cases, with symptoms including itching, redness, swelling, and a thick white discharge. Severe cases may involve extensive vulvar edema, excoriation, fissures, or more intense discomfort. Without proper treatment, it can significantly impact quality of life.
Healthcare Professionals: Disease Ontology ID - DOID:2272
Pathophysiology: Pathophysiology:
Vulvovaginal candidiasis is caused by an overgrowth of Candida species, primarily Candida albicans, in the vaginal area. This opportunistic yeast exploits changes in the vaginal environment, such as alterations in pH, disruption of normal bacterial flora, or immunosuppression. When the balance of microbial flora is disturbed, Candida can proliferate, leading to inflammation, itching, discharge, and discomfort. Factors contributing to this imbalance include antibiotic use, hormonal changes (e.g., pregnancy, oral contraceptives), diabetes, and immunocompromised states.

Nan (not applicable in this context):
The term "nan" does not apply to the specifics of vulvovaginal candidiasis. If "nan" refers to something else, please provide additional context for a more accurate response.
Carrier Status: Vulvovaginal candidiasis, commonly known as a yeast infection, is primarily caused by an overgrowth of Candida species, most frequently Candida albicans. Carrier status refers to individuals who harbor the organism without showing symptoms. It is common for many women to carry Candida species in their vaginal flora without experiencing symptoms. Factors such as antibiotic use, high estrogen levels, uncontrolled diabetes, and a weakened immune system can trigger symptomatic infections in these carriers.
Mechanism: Vulvovaginal candidiasis (VVC) is primarily caused by an overgrowth of the yeast Candida, most commonly Candida albicans. It occurs when the natural balance of microorganisms in the vaginal area is disrupted.

**Mechanism:**
The Candida species are part of the normal microbial flora in the vagina. Typically, they exist in a commensal relationship with the host and are kept in check by the immune system and the competitive microbial environment. When factors such as antibiotic use, hormonal changes, immunosuppression, or changes in the vaginal pH disrupt this balance, Candida can overgrow and cause infection.

**Molecular Mechanisms:**
1. **Adhesion to Epithelial Cells:** Candida can adhere to epithelial cells of the vaginal mucosa through adhesins and surface proteins, facilitating colonization.
2. **Biofilm Formation:** Candida species can form biofilms, which are structured microbial communities that are highly resistant to antifungal treatments and immune response.
3. **Morphogenesis:** Candida albicans has the ability to switch between yeast and hyphal forms, a process known as dimorphism. The hyphal form is associated with increased virulence as it can invade tissues more effectively.
4. **Evasion of the Immune System:** Candida can evade host immune responses by secreting enzymes such as proteases and lipases, which degrade host proteins and lipids, and by masking its cell wall components to avoid detection.
5. **Regulation of pH:** Candida can also modify the local pH to create a more favorable environment for its growth, often through the production of metabolic byproducts like ammonia.

Understanding these molecular mechanisms is crucial for developing targeted therapies for VVC and for managing its recurrence.
Treatment: The following treatments are typically recommended:

Intravaginal (vaginal suppository): butoconazole, clotrimazole, miconazole, nystatin, tioconazole, terconazole. Candidal vulvovaginitis in pregnancy should be treated with intravaginal clotrimazole or nystatin for at least 7 days. All are more or less equally effective.
By mouth: ibrexafungerp, fluconazole as a single dose. For severe disease another dose after 3 days may be used.Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated candidal vulvovaginitis. The topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures in 80–90% of patients who complete therapy.The creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms. Treatment for vagina thrush using antifungal medication is ineffective in up to 20% of cases. Treatment for thrush is considered to have failed if the symptoms do not clear within 7–14 days. There are a number of reasons for treatment failure. For example, if the infection is a different kind, such as bacterial vaginosis (the most common cause of abnormal vaginal discharge), rather than thrush.Vaginal boric acid has evidence of effectiveness against non-C. albicans species.
Compassionate Use Treatment: Compassionate use treatment and off-label or experimental treatments for vulvovaginal candidiasis can include the following:

1. **Boric Acid**: Used intravaginally as a suppository, boric acid is often considered an effective treatment, especially in cases of recurrent or treatment-resistant infections.

2. **Flucytosine**: This antifungal can be used intravaginally, sometimes in combination with amphotericin B. It is considered in cases where conventional antifungal therapies have failed.

3. **Probiotics**: Certain strains of Lactobacillus, when administered either orally or intravaginally, may help in restoring normal vaginal flora and reducing the recurrence of infections.

4. **Itraconazole**: Though it is primarily an antifungal for systemic infections, itraconazole may be used off-label for vulvovaginal candidiasis, particularly in cases resistant to first-line treatments.

5. **Photodynamic Therapy (PDT)**: An experimental approach under investigation, PDT uses light-sensitive compounds and light exposure to destroy fungal cells.

These treatments should be considered in consultation with a healthcare professional, especially in cases where standard therapies are ineffective.
Lifestyle Recommendations: For vulvovaginal candidiasis, also known as a yeast infection, consider the following lifestyle recommendations:

1. **Maintain Good Hygiene**: Keep the genital area clean and dry. Avoid using scented soaps or body washes, which can irritate the area.

2. **Wear Breathable Underwear**: Choose cotton underwear and avoid wearing tight-fitting clothing to reduce moisture build-up.

3. **Avoid Douching**: Douching can disrupt the natural balance of bacteria and yeast in the vagina, potentially worsening the condition.

4. **Dietary Adjustments**: Consider reducing sugar intake as high sugar levels can promote yeast growth. Eating probiotic-rich foods like yogurt may help maintain healthy vaginal flora.

5. **Change Out of Wet Clothing**: After swimming or exercising, change out of wet clothes as soon as possible to prevent moisture buildup.

6. **Watch for Triggers**: Certain products like scented sanitary pads, tampons, or bath products can act as irritants. Avoiding them may help prevent recurrence.

7. **Healthy Lifestyle**: Strengthen your immune system by maintaining a balanced diet, exercising regularly, and getting adequate sleep.

If symptoms persist, consult a healthcare provider for appropriate diagnosis and treatment.
Medication: Infection occurs in about 30% of women who are taking a course of antibiotics by mouth. Broad-spectrum antibiotics kill healthy bacteria in the vagina, such as Lactobacillus. These bacteria normally help to limit yeast colonization.Oral contraceptive use is also associated with increased risk of vaginal thrush.
Repurposable Drugs: Repurposable drugs for vulvovaginal candidiasis include:

1. **Fluconazole** - An antifungal commonly used to treat candidiasis, it is often prescribed in a single oral dose.
2. **Itraconazole** - Another antifungal, which can be effective in cases where fluconazole is not suitable.
3. **Clotrimazole** - Available as a topical cream or suppository, it is often used for local treatment.

These drugs have a history of use for treating fungal infections and may be repurposed for vulvovaginal candidiasis based on their antifungal properties.
Metabolites: For vulvovaginal candidiasis, some of the key metabolites often associated include:

1. **Ethanol**: Produced during the fermentation of glucose by Candida species.
2. **Acetaldehyde**: An intermediate in ethanol metabolism.
3. **Glucose**: Utilized by Candida for energy.
4. **Glycerol**: A byproduct of carbohydrate metabolism.
5. **Lactic Acid**: Produced during carbohydrate fermentation.

These metabolites can affect the local environment in the vagina, contribute to symptoms, and provide potential targets for diagnosis and treatment.
Nutraceuticals: For vulvovaginal candidiasis, nutraceuticals such as probiotics (e.g., Lactobacillus species) and garlic supplements have been investigated for their potential to prevent or alleviate symptoms. However, their effectiveness can vary, and they should be considered complementary to conventional treatments like antifungal medications. Always consult a healthcare provider before starting any new supplements.
Peptides: In the context of vulvovaginal candidiasis, peptides and nanoparticles (nan) are explored as potential therapeutic options. Antimicrobial peptides (AMPs) have shown promise due to their ability to target and disrupt the cell membranes of Candida species, potentially overcoming resistance seen with traditional antifungal treatments. Nanoparticles, particularly those made from silver, chitosan, or liposomes, are being investigated for their ability to deliver antifungal agents more effectively, improve drug stability, and reduce side effects by targeting the site of infection more precisely.