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Article: Vaginitis
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Sexually Transmitted Diseases


Sexually Transmitted Diseases

Vaginal Yeast Infections

Vulvovaginal candidiasis, known as vaginal yeast infections, affects the lower genital tract of women. Recently, advances in molecular epidemiology, host mucosal immunology, and antifungal treatment have brought up investigations into this common infection.

Women spent over half a billion dollars on medications to treat vulvovaginal candidiasis in 2002. Half of this amount was spent on over-the-counter preparations. However, many women wrongly diagnose the condition and may actually suffer from bacterial vaginosis.

It is hard to find data on the epidemiology of vulvovaginal candidiasis, likely because vaginal colonization with Candida, which is a prerequisite for the condition, occurs in at least 40 percent of adult women.

According to experts, at least half of women will experience vulvovaginal candidiasis by their mid-20s, and up to 25 percent of these women will suffer from four or more episodes a year.

Women with poorly controlled diabetes, systemic immunosuppression or immunodeficiency, and who use antibiotics may be predisposed to vulvovaginal candidiasis, however the pathogenesis of recurring vulvovaginal candidiasis among women with no known risk factors is under investigation.

Recurrent disease likely involves some breakdown of the normal mucosal immune processes that allow for mucosal "tolerance" to the organism. Behavioral risk factors for recurrent vulvovaginal candidiasis are unclear, however investigators have suggested that receptive oral sex and increasing frequency of intercourse may play a role.

The effectiveness of suppressive treatment for women with recurrent infections has recently been validated. Taking weekly medication after an initial regimen of topical imidazole or oral fluconazole works well. However, it can be difficult to determine when to stop such a regimen, as once the medication is stopped the episodes may start up again.

Investigators note that many symptoms attributed to vulvovaginal candidiasis are actually caused by bacterial vaginosis, the most common cause of vaginitis among women. Bacterial vaginosis is often diagnosed with vulvovaginal candidiasis. Genital herpes and genital dermatitis, such as lichen planus, may also be misdiagnosed as recurrent vulvovaginal candidiasis.

There is debate over the effectiveness of vaginal fungal cultures, however most experts agree that they can enhance the sensitivity of diagnosis of vulvovaginal candidiasis in women.

BMJ May 10, 2003;326:993-994 (Full Text Article)

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