Definition

Vaginal candidiasis is a fungal infection that causes irritation, severe itching, and thick discharge in the vagina and vulva (the outer part of the female genitalia). This infection typically affects 3 out of 4 women at some point in their lives. Many women will experience at least two episodes of candidiasis in their lifetime. 5% of women may suffer from recurrent vaginal candidiasis, where the infection can occur ≥4 times in a year.

In the United States, vaginal candidiasis is the second most common type of vaginal infection after bacterial vaginosis. It is estimated that around 1.4 million patients visit healthcare facilities due to vaginal candidiasis.

This fungal infection can be effectively treated with medication. However, treatment can take longer if vaginal candidiasis frequently recurs or relapses. If left untreated, fungal infections can cause other health problems.

Causes

Vaginal candidiasis is caused by the fungus Candida albicans. This fungus normally lives on the skin and in the mouth, throat, intestines, and vagina. Typically, it does not cause problems in the body. Fungal infections caused by other types of candida fungi are generally harder to treat and require stronger therapy.

Normally, there are several fungi and bacteria in the vagina. Certain bacteria, such as Lactobacillus, play a role in preventing fungi from growing excessively. Fungal infections usually occur when candida fungi grow excessively and disrupt the balance of other microbes. The fungus can also penetrate deeper into the vaginal lining, causing inflammation.

Risk Factor

Although this infection is not classified as a sexually transmitted infection, there is an increased risk of vaginal candidiasis during the first instances of regular sexual activity. Fungal infections can also be associated with orogenital sexual activity (mouth and genital contact).

Several factors can increase the risk of women experiencing vaginal candidiasis, including:

• Frequent use of broad-spectrum antibiotics is often associated with fungal infections
• Increased estrogen levels, such as in pregnant women, those taking birth control pills, or undergoing hormone therapy
• Uncontrolled blood sugar levels in diabetes mellitus
• A weakened immune system can make someone more susceptible to infections. This condition can be experienced by women who are:
• Undergoing corticosteroid or chemotherapy treatment for cancer
• Infected with HIV
• Suffering from autoimmune diseases (conditions where immune cells attack healthy body cells)

Symptoms

Symptoms of vaginal candidiasis are usually mild. Patients generally complain of the following:

• Itching, irritation, or burning sensation in the vagina and vulva
• Pain during sexual intercourse or urination
• Red rashes and swelling in the vulva and vagina
• Vaginal discharge may appear or not in some patients. The discharge is usually white, thick, odorless, and resembles cottage cheese. These complaints often become prominent before the patient's menstrual period

In severe fungal infections caused by rarer types of fungi, severe irritation, redness, swelling, sores, and tears in the vaginal wall can occur. Recurrent complaints (≥4 times a year) indicate that you are suffering from recurrent vaginal candidiasis.

Diagnosis

The doctor will ask detailed questions about your current complaints, whether the complaints are being experienced for the first time or have recurred multiple times. The doctor will investigate if the complaints are caused by a fungal infection or other factors, such as allergic reactions to clothing, sanitary pads, or soap. The doctor may also inquire about your medical history, daily habits, and sexual behavior.

Next, the doctor will examine the pelvis and genital area to look for signs of infection. Samples from the vagina can be checked for pH levels and examined under a microscope. These samples can also be cultured to check for the presence of fungi (fungal culture). A positive fungal culture does not always indicate that candida fungi are causing the complaints.

In a whiff test, if the patient has vaginal candidiasis, when a sample of discharge is mixed with KOH solution, it will not produce a fishy smell. The absence of a specific odor indicates a negative result for the whiff test.

Management

Treatment of vaginal candidiasis depends on the severity of the disease and the frequency of infections. Generally, the doctor will prescribe antifungal medications to address the excessive fungal growth. The medication can be administered for a day or several days in the form of oral medication, gels, ointments, or creams. Antifungal drugs such as fluconazole can be given to treat vaginal candidiasis. Inform your doctor if you are allergic to fluconazole or certain antifungals.

For pregnant women with vaginal candidiasis, antifungals are usually given in the form of ointments or vaginal gels, not oral medication. Fluconazole is considered safe for breastfeeding mothers. You need to consult your doctor if the therapy does not relieve the symptoms or if symptoms reappear within two months.

Longer treatment is usually provided for patients with severe infections or weakened immune systems. Therapy can last for several months. Recurrent candidiasis may require maintenance therapy to prevent recurrences, although this treatment is not recommended for pregnant women.

Complications

If left untreated, vaginal candidiasis can worsen, causing complaints such as itching, redness, and inflammation in the vaginal area. If you scratch the genital area and cause sores, the sores can become infected with bacteria, making the condition worse.

Prevention

This condition can be prevented. To reduce the risk of vaginal candidiasis, you can take the following steps:

• Avoid wearing tight underwear and use cotton underwear.
• Avoid washing the genital area with specific solutions or liquids, as this habit can reduce the number of normal bacteria in the vagina that help maintain the vaginal environment's balance.
• Avoid excessive use of antibiotics; only use antibiotics as prescribed by your doctor.
• Do not wear wet clothing, such as swimsuits and sportswear, for long periods.

When to See a Doctor?

Contact your doctor if you have any symptoms of vaginal candidiasis. Symptoms of candidiasis can resemble complaints of other vaginal infections. The doctor will examine your condition and provide appropriate therapy.

Do not delay seeing a doctor if you have experienced complaints such as:

• Discharge with odor, yellow color, or accompanied by blood
• Fever
• Pelvic or abdominal pain
• Vomiting
• Urinary complaints

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