Vaginal candidiasis - is a fungal infection of the vaginal mucosa, which often takes the form of vulvovaginal, rarely observed in patients fungal dermatitis of the vulva.Candida infection is detected in 26-45% of women with vaginal discharge.
cause of vaginal candidiasis are yeast-like fungi Candida.They are part of the normal vaginal microflora, but do not fall outside the body, like other infectious agents.
microorganisms comprising the normal vaginal flora, occupy niches and are required in some competitive relationship with each other "useful" microflora has a numerical advantage and prevents unwanted microbes to multiply and cause disease.
normal vaginal microflora in their composition in different stages of life is not the same.Newborn girls vagina is sterile, and the first three weeks is influenced by maternal estrogen.When the mother's hormones are derived from the child's body completely independent gradual begins "colonization" of the vaginal mucosa represen
The normal vaginal flora is composed predominantly healthy women (95- 98%) of 9 species of lactic acid bacteria (lactobacilli) and a small number of opportunistic pathogens: Staphylococcus, Streptococcus, anaerobic bacteria, Gardnerella, mikopplazmy and so on.Qualitative composition ratio microbes pathogenic microflora each woman individually, but their total amount in any case so small that it is not harmful as long as lactobacilli have numerical advantage.
in the surface layer of cells lining the vagina contains glycogen, its amount is regulated by estrogens.Lactobacilli split it into lactic acid, thereby maintaining a constant acidity (pH) of 3.8 - 4.5.Representatives lactoflora peculiar form microcolonies and attach to the surface of the vaginal mucosa, epithelial cells surrounded by the products of its life and create a protective biofilm - glycocalyx.
numerical advantage lactic acid microflora of the vagina provides protection against infection and inflammation.Conditionally pathogenic microbes can not increase its strength due to the presence of lactic acid in the vagina, but they penetrate into the mucous prevents glycocalyx.In response to the quantitative reduction of lactobacilli increases the number of opportunistic pathogens, and reduced ability to resist infection of the vaginal mucosa.
Candida fungi are found in small amounts in the vagina of healthy women in a group of opportunistic pathogens.If the normal vaginal microflora unwanted changes occur, the fungal population may begin to proliferate.Normal body temperature and slightly acidic environment of the vagina are favorable for fungal overgrowth population.With the unique ability to penetrate into the deeper layers of the surface epithelium, candida flora provokes the development of an infectious process.
vaginal microenvironment is a self-regulating dynamic system, and throughout their lives in every woman there are fluctuations of its parameters.Almost 75% of the female population had a single episode of vaginal candidiasis.On the constancy of the vaginal environment influenced by many physiological or pathological factors, but not every deviation from the norm leads to the development of the disease.
Pregnancy is one of the most popular physiological causes of vaginal candidiasis.Compared to non-pregnant women, vaginal candidiasis in pregnancy is detected in 2-3 times more often.In most cases, vaginal candidiasis in pregnancy is diagnosed in the first and the last trimester.
most common vaginal candidiasis occurs in children between the ages of three and seven years, or at puberty.It is diagnosed in 25% of adolescents with inflammatory diseases of the genitalia.
Older women in the background extinction hormonal function is a natural decrease in the number of lactobacilli in the vagina.
Vaginal candidiasis different bright clinic, persistent course and the ability to relapse.However, symptoms of vaginal candidiasis in women with a good immune system can be expressed poorly or be eliminated themselves.
reasons for vaginal candidiasis
only credible cause of Candida infections is the excessive proliferation of Candida fungi, provided decrease of general and local immunity.
predispose to disease factors may be:
- Uncontrolled or too frequent use of antibiotics, which reduce local immune system and inhibit the growth of normal microflora, suppresses the development of Candida.
- Injury vaginal mucosa of various origins.Violation of the integrity of the vaginal epithelium is accompanied by damage to the protective "film", which form the lactobacilli.Damaged parts of the mucous becomes defenseless before the opportunistic microbes.
- Diabetes.Violation of glucose metabolism leads to increased sugar content in cells of the vaginal mucosa and reduction in the amount of lactic acid bacteria.Besides diabetes affects the immune system.
- Pregnancy.Since the amount of glycogen in the vagina is controlled by estrogen, natural hormonal changes during pregnancy in combination with immune disorders create favorable conditions for the development of vaginal candidiasis.
- menopause.In postmenopausal vagina occurs thinning mucus layer (atorofiya).Atrophic mucosa contains little glycogen, thereby reducing the number of lactobacilli.
- hormonal drugs, especially contraceptives.Oral contraceptives artificially regulate the levels of estrogen in the body.Lack of normal cyclical changes in vaginal epithelium depletes glycogen stores, and reduces the concentration of lactobacilli.
- Inflammation of the vagina.Vaginal mucosa during inflammation loses its natural protective properties and becomes vulnerable.
- Bacterial vaginosis.Against the background of dysbiosis vaginal fungal flora is developing successfully and calls the phenomenon of candidiasis.
- Allergic and immunodeficiency diseases.
- Intestinal dysbacteriosis and chronic gastrointestinal disease.
- drug therapy, depressing the immune system.These include cytostatics and corticosteroids.
- childhood.The structure of the vaginal mucosa and increased allergy can cause vaginal candidiasis in children two - seven years.Candida fungi are the second leading cause of vulvovaginitis in children.
- Adolescence.At puberty marked physiological hormonal dysfunction, and increased risk of violations normobiotsenoza vagina.
- Failure to comply with the rules of intimate hygiene.Candida fungi are present not only in the mucous membranes.They can be found in healthy individuals in the mouth, on the skin around the orifices and hands (- especially at the fingertips).In the absence of proper hygiene can get a fungal flora in the vagina with the tissue surrounding the vulva.Often it is a violation of hygiene norms provokes vaginal candidiasis in children.
completely unresolved is the question of "infectiousness" of vaginal candidiasis.The fact of the presence of Candida in men can not be absolute proof of sexual spread of fungal infections.It confirmed cases of candidiasis in infants and are not sexually active women.An exception can be considered a situation of candidiasis symptoms in a healthy sexual partner, regularly and for a long time living with a woman who has long expressed an existing candida without appropriate therapy.
Symptoms of vaginal candidiasis
Vaginal candidiasis infectious process develops mainly in the surface layer of the vaginal epithelium.At this level, the fungal population is in close cooperation with other members of the vaginal microflora, so the scenario of the disease depends on the condition of the vaginal environment and its microbial composition.With the reduction of the level of lactobacilli in the vagina multiply not only fungi but also other representatives of conditionally pathogenic microflora, which can form associations and competitively displace the fungal population or "help" it to develop.For example, 20% of the patients symptoms of vaginal candidosis and gardnerellezom combined with trichomoniasis.
With moderate dysbiosis vaginal lactobacilli reduced the number, but they can still inhibit the growth of fungal flora, not allowing it to penetrate into the deeper layers of the mucosa, but they are not enough to completely remove the fungus from the body.There is a specific balance between lactobacilli and fungi, so that the disease "dormant."A further scenario can occur in several ways:
- This balance is maintained for a long time in the form kandidonositelstvo and does not lead to negative consequences, therefore refers to any disease, and to the characterization of the state of the vaginal environment.
- body due to internal reserves restores the proper ratio of lactic acid and conditionally pathogenic microflora, dysbacteriosis eliminated, and fungi are killed, then there comes the recovery.Typically, in such a scenario develops acute vaginal candidiasis in healthy women with good immune systems.
- internal resources of an organism is not enough for complete elimination of infection, but they continue to hinder its further development for some time, and chronic vaginal candidiasis is in remission.
- Significant depletion of local and general immunity leads to further aggravation of infection, causing a worsening of the disease.Chronic recurrent vaginal candidiasis develops in frail patients with adverse gynecological history and extragenital pathology.
often during the conversation the patient very accurately called the situation and provoke the emergence of symptoms of vaginal candidiasis - antibiotics or hormonal agents, stress, trauma, inflammation of the genital organs and so on.
Since fungi are often included in the composition of microbial associations, symptoms of vaginal candidiasis is a great variety.The disease has only one common symptom - itching of the external genitalia and vagina.Often accompanied by itching in the vagina burning sensation, increased in the second half of the day, at night, after contact with water, sexual contact, or long distance.For vaginal candidiasis is characterized by cyclical itching and burning, they are amplified before menstruation.Even when there is no visual evidence of the presence of Candida infection itching requires research on fungal flora.
Vaginal discharge fungal infections have developed their distinctive properties.Heavy to moderate gray-white discharge with vaginal candidiasis are similar to cottage cheese to include a white small lumps or flakes.
Fungal infections can cause severe inflammation, which is spreading rapidly in the area of the vulva and urethra (urethritis), so acute vaginal candidiasis accompanied by pain in the vulva and vagina and urinary disorders.
severity of symptoms depends on its shape.Recurrent chronic vaginal candidiasis may have erased the symptoms, and the diagnosis of acute inflammation may be installed in the early stages of the survey.
During the inspection of the mucous shows signs of inflammation - edema and hyperemia.Characteristic sign of vaginal candidiasis are dense gray-white deposits on the mucosa after removal of their place are a little bleeding areas strongly pronounced inflammation.
Itching vaginal candidiasis is so strong that it does not allow the patient to lead a normal life, because it interferes with sleep, move, take a shower and sexually active, it becomes irritable.
kandidonositelstvo has no symptoms and is detected only by laboratory tests.At gynecological examination the mucous have a normal, healthy appearance.
Vaginal candidiasis in children occurs in the form of acute, chronic and recurrent inflammation or kandidonositelstvo.The main symptoms of candidiasis in children is an expression of itching in the perineum and vulva, and burning during urination.On examination, the skin of the vulva swelling, has traces of scratching.Like adult women, on the mucosa of the vulva are specific candida attacks.
vaginal pH measurement is carried out while the content inspection and helps in the diagnosis in the absence of pronounced symptoms of vulvovaginal inflammation.Used indicator test strip with a scale division.For vaginal candidiasis is characterized by change in acidity in the range 4.0 - 4.5.
Complicated untreated form of vaginal candidiasis is rare.Usually the disease is detected and treated beginning in the early stages.
After the conversation and examination of vaginal candidiasis preliminary diagnosis must be confirmed by laboratory tests.Microscopic examination of vaginal discharge can detect fungal spores or mycelium and determine the form of Candida infection: asymptomatic carriage, a true combination of candidiasis and candidiasis and bacterial vaginosis.
self-diagnosis of vaginal candidiasis is unacceptable.Independently deliver reliable diagnosis of vaginal candidiasis is sometimes difficult.Often present in the vagina pathogenic microflora distorts, "erases" the symptoms of a fungal infection or "masked" by candidiasis.
treatment of vaginal candidiasis
Vaginal candidiasis develops in the presence of precipitating factors.To vulvovaginal inflammation therapy has conceived the expected effect, you must first eliminate all triggers disease factors.To do this, the patient is asked to comply with the period of therapy simple rules:
- Eat right.The quantitative decline in the proportion of carbohydrates in the diet helps the body cope with the disease.
- Refusal of bad habits.
- sexual rest.
- Do not take anti-bacterial and hormonal agents.
- observe good personal hygiene.
primary cases of acute vaginal candidiasis usually respond well to simple local therapy with antifungal drugs to cure the recurrent vaginal candidiasis is much more difficult.
One important advantage of a large number of antifungal agents is the possibility of local application as ointments, creams, gels and vaginal suppositories.Unlike tablets they do not have negative side effects on the organism, convenient to use, and the opportunity to take the medication directly to the site of inflammation allows to achieve a better therapeutic effect.In the case of chronic recurrent process local therapy can not cope with the infection and needs the support of systemic medications (pills).
To vaginal flora regained its proper parameters, it is necessary not only to eliminate pathogens, but also to create favorable conditions for the growth of lactobacilli.After a two-week course of antibiotic therapy, as necessary, the elimination of vaginal dysbiosis.
Symptomatic therapy includes the use of antihistamines, analgesics and immunostimulants, and treatment of extragenital pathology.
treatment of vaginal candidiasis in pregnant women is carried out taking into account the possible negative effects of antibiotics on the fetus.