1 / 25

Vulvovaginal candidiasis (VVC)

Vulvovaginal candidiasis (VVC). Louise Oliver GP Extension Registrar GU Medicine. Size of the problem. 55% of women by mid 20s have had VVC Geiger AM, Foxman B, Gillespie BW. AmJ Pub Hlth 1995; 85 :1146-1148. Up to ¾ of all women at least 1 lifetime episode

Lucy
Download Presentation

Vulvovaginal candidiasis (VVC)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Vulvovaginal candidiasis (VVC) Louise Oliver GP Extension Registrar GU Medicine

  2. Size of the problem • 55% of women by mid 20s have had VVC Geiger AM, Foxman B, Gillespie BW. AmJ Pub Hlth 1995;85:1146-1148. • Up to ¾ of all women at least 1 lifetime episode • $58.4 million per year $19.8 in medication costs Foxman B, et al STDs 2000;27:230-235.

  3. Consequences • Not directly life threatening but….. • Poor self esteem. • Psychosexual problems.Stewart DE, Whelan CI, et al Obstetrics & Gynecology 1990;76 :852-856. Irving G et al. STIs. 74(5):334-8, 1998 Oct. 99210932 • Socially unacceptable to discuss • Often misunderstood/dismissed by health professionals

  4. Causative agent • C. albicans 85-90% • C. glabrata 5-10% • Others: C.tropicalis, C.krusei, C. kefyr, & Saccharomyces cerevesiae (Brewer’s yeast)

  5. Symptoms • Vulval itching or soreness • Vaginal discharge • Superficial dysparenuia • External dysuria

  6. Signs • Erythema • Fissuring • Non offensive discharge • Satellite lesions • Oedema

  7. Investigations • GUM setting: • Gram stain or saline microscopy of anterior fornix or lateral vaginal wall discharge • Culture • GP setting: • Charcoal swab for culture

  8. Classification of VVC Sobel JD et al, Am J Obs Gynecol 1998;178:203-211. • 1 Candida colonisation • 2 Uncomplicated VVC • 3 Complicated VVC

  9. 1 Candida colonisation • Candida is an opportunist pathogen • Normal vaginal flora in many women • 27% in longitudinal studyPriestley CJ et Genitourin Med1997;73:23-28. • Higher in pregnancy (30-40%) • Positive HVS for Candida doesn’t distinguish between commensal and pathogen

  10. 2 Uncomplicated VVC • mild • infrequent • non-persistent • non-pregnant women

  11. 3 Complicated VVC • severe, persistent, recurrent VVC or underlying host abnormality • Divided into: • 1 severe vulvovaginal candidiasis • 2 persistent non- albicans infection • 3 recurrent vaginal candidiasis

  12. Treatment • National guidelines www.mssvd.org.uk • General advice • Topical & oral azole therapy 80-95% cure rate (non-pregnant women) • Oral azole therapy avoid in pregnancy & breast feeding • Do not treat asymptomatic Candida colonisation

  13. Topical therapy( given PV) • Clotrimazole 500mg stat/ 200mg x 3/7 / 100mg x 6/7 / 10% vaginal cream 5g stat • Econazole 150mg stat/ 150mg x 3/7 • Fenticonazole 600mg stat/ 200mg x 3/7 • Isoconazole 2 x 300mg stat • Miconazole 1.2g stat/ 100mg x 14/7 • Nystatin 4g cream x 14/7 / 1-2 pessaries x 14/7

  14. Oral therapy • Fluconazole 150mg PO stat • Itraconazole 200mg PO BD 1 day

  15. Choice of therapy • Oral • more acceptable to some • ?quicker onset • systemic side effects • ?not safe in pregnancy • Vaginal • messy • occasional irritation

  16. Sexual partner • Grade A evidence to show treatment of asymptomatic male sexual partnersis not required

  17. Follow up • Unnecessary if symptoms resolve • Test of cure unnecessary

  18. Symptoms fail to settle • Severe VVC - repeat fluconazole 150mgs after 3 days Sobel JD et al Am J Obs Gynae 2001;185:363-369. • ? Non albicans infection • ? Recurrent VVC • ? Irritation secondary to topical therapy • ? Wrong diagnosis

  19. Differential diagnosis • Trichomonas vaginalis • Bacterial vaginosis • Herpes simplex virus • Vulval disease • Chlamydia • Gonorrhoea

  20. 125 women referred with “problem thrush” to Dr David White at Hawthorn House, Heartlands Hospital

  21. ? Recurrent VVC • Research area • Speciated fungal culture • ??FBC and random glucose • ??HIV test only mandatory if other indication • Symptom diary • Self taken swabs • equivalent to doctor/nurse swabs Blake DR, et al Pediatrics 1998;102:939-944. • Give treatment to take after swab taken

  22. Recurrent VVC • ? GUM referral • Could try regime recommended by MSSVD but unlicenced! • Fluconazole PO 100mg weekly x 6/12 • Clotrimazole PV 500mg weekly x 6/12 • Itraconazole PO 400mg monthly x 6/12

  23. Contraception & recurrent VVC • Whether pill causes VVC unclear • DepoProvera protective • small retrospective study • reduced Candida colonisation in prospective study • Norplant associated with reduced incidence of vaginitis

  24. “Alternative” treatment • Due to “overgrowth of Candida in bowel”????? • Yoghurt and lactobacillus acidophilus • lactobacillus vaginal flora not protective • intravaginal ineffective but soothing Bisschop MP, et al Ned Tijdsch Geneesk 1987;131:159-161 • yoghurt effective growth media for Candida • Oral lactobacilli may be effective Hilton E et al Ann Int Med 1992;116:353-357. • ??atopy mediated Isolauri E et al Am J Clin Nutr 2001;73:444S-450S. Kalliomaki M, et al Lancet 2001;357:1076-1079.

  25. Summary • No pathognomic feature • Itching is only predictive symptom/sign • Diagnosis needs laboratory confirmation • Symptoms/signs no guide to species • Asymptomatic male partners don’t require treatment • Remember to enclose copies of positive swabs when referring • Consider differential diagnosis

More Related