Vaginal candidiasis – this diagnosis was made at least once in the life of almost every woman. It is a collection of fungal diseases of an infectious nature, proceeding in the form of vulvovaginitis or, less often, fungal dermatitis of the vulva. They are so common that candida infection can be detected in 45% of women who have a discharge.
Source of infection: about the pathogen
The causative agent of vaginal candidiasis are specific yeast-like fungi belonging to the known genus Candida. The peculiarity of these microorganisms is that they are part of the natural vaginal flora, and do not enter the body immediately before the onset of the manifestations of the disease. Representatives of our flora are in a kind of competitive relationship. The beneficial microflora has a numerical advantage. For example, on the mucous membrane of the female vagina, the number of lactobacilli exceeds 95%. They prevent fungal agents from multiplying. The nature of candida is symbiotic: they are able to peacefully coexist with other representatives of microflora, while not harming the human body.
In order to maintain the ability to multiply and not die, fungi hide behind a protective shell. When the balance of microorganisms in the female vagina is disturbed, candida expose their cells and begin to multiply in a spore manner. New individuals create chains that turn into colonies. The causative agent of thrush begins to infect the cells – it immediately acts on the epithelium, and then penetrates deeper. Its pathogenic effect is expressed through the poisoning of cells with toxins after the fungus “takes away” all the useful substances that interest it.
Features of female microflora
At different periods of life, the composition of the microflora of the female vagina is very different. So, in newborn girls, the vaginal mucous membranes are sterile. During the first three weeks, he is still affected by maternal estrogens, and after the mother’s hormones are completely eliminated from the body, microorganisms settle in the vagina, which will make up the microflora. In adolescence, the flora of a girl becomes identical to an adult, fully consistent with her composition. In addition to a large number of lactobacilli (their number can reach 95-98%). They are lactobacilli or lactic acid bacteria of nine different species. Conditionally pathogenic microorganisms coexist with them:
- Anaerobic bacteria
Of course, the percentage of representatives of opportunistic flora is individual for each woman. Moreover, the total number of conditional threats is too small to cause harm. The superficial layer of the vagina contains glycogen, the amount of which is regulated by estrogen. Lactobacilli are involved in the breakdown of glycogen to lactic acids, which maintain the acidity level on the mucous membranes. Lactoflora also unites in colonies, and then becomes attached to the mucous membranes of the vagina. As a result, epithelial cells are surrounded by the vital products of lactobacilli in the form of a special biofilm – a protective glycocalyx. Lactic acid does not allow opportunistic microorganisms to multiply, protecting the body from inflammation and infections. Lactic acid also helps regulate the candida population. Penetration into the mucosa is prevented by glycocalyx. But as soon as the number of lactobacilli decreases , the number of conditionally pathogenic flora increases, and the protective abilities of the vaginal mucosa are significantly reduced.
Manifestations of vaginal candidiasis at different periods
The self-regulating dynamic system, which is the flora of our vagina, can malfunction. Fluctuations in her parameters accompany a woman constantly, they can be associated with different life stages and simply cyclical changes. 75% of women claim that they have encountered such a phenomenon as thrush at least once. However, not all deviations from the norm can affect the development of the disease. One of the most common causes of vaginal candidiasis is called pregnancy. During this period, the frequency of cases increases almost 3 times. Most often, the disease manifests itself in the first and last trimesters. At the beginning of pregnancy, there is literally a crazy hormonal surge, so the composition of the microflora can change significantly. In recent months, the load on the woman’s body has been increasing as much as possible, the body can weaken under the influence of a variety of external and internal factors. Against this background, genital candidiasis willingly develops . The same diagnosis can be made not only for adult women, but also for children. Girls at three, seven years old, and then during puberty are often victims of infection. If a teenager has an inflammatory disease on the genitals, then in 25% of cases it is the development of the fungus that becomes its cause. Vaginal candidiasis does not spare older women. During the period when hormonal functions fade away, a decrease in lactobacilli in the vagina is considered quite natural. Candida use this state with pleasure. In the period before menstruation, the number of estrogen changes, which entails changes in the composition of the flora and acidity. Therefore, chronic thrush usually manifests itself a week before the onset of menstruation. After they are over, the acidity returns to normal, so candidiasis itself fades away. Usually, the disease has a rather bright clinic, a persistent course and a recurrent nature. Moreover, if a woman has a good immune system, then the symptoms may be mild, and then disappear on their own.
Why is thrush worried: reasons
The cause of the development of the disease is the excessive reproduction of the fungal flora in the vagina. It occurs against the background of a general decrease in immunity. There are also a number of predisposing factors that contribute to the fact that thrush manifests itself as a disease:
- Antibiotics (if they are used very often or uncontrollably) that reduce local immunity, as well as adversely affect the growth of beneficial microflora.
- Injuries that are on the vaginal mucosa: for a number of reasons, it is possible to violate the integrity of the vaginal epithelium with simultaneous damage to the protective layer of lactobacilli. As a result, these areas are defenseless when exposed to infection.
- Diabetes mellitus is accompanied by impaired glucose metabolism, therefore, the sugar content in the epithelial cells of the vagina increases, which leads to a decrease in the number of beneficial bacteria. Also, diabetes in itself greatly affects the immune system, reducing its protective abilities.
- Pregnancy, as already mentioned, is a very favorable period for fungal agents. Hormonal changes at this time are combined with immune disorders, which gives rise to the reproduction of harmful microorganisms.
- The climacteric period is characterized by atrophy (thinning) of the natural mucous layer. As a result, such mucosa contains less glycogen, and the number of lactobacilli decreases.
- Hormonal drugs (especially if they are oral contraceptives) artificially regulate the level of female estrogen. If natural cyclic changes occur under the pressure of drugs, then this again affects the concentration of glycogen.
- Inflammatory processes of the reproductive system lead to the fact that the mucous membrane becomes vulnerable, losing its natural protective properties.
- Bacterial vaginosis can be a backdrop for yeast infection in the vagina.
- Intestinal dysbiosis, as well as other chronic ailments associated with the work of the gastrointestinal tract, can provoke the growth of candida.
- Drugs that suppress the immune system – corticosteroids, cytostatics, immunosuppressants – can lead to the fact that protective mechanisms cannot work with sufficient force.
- Allergies and immunodeficiencies also seriously reduce immunity.
- Children’s age from two to seven years is characterized by increased allergization, in addition, the structure of the vaginal mucosa during this period is somewhat “inferior” due to insufficient maturation, therefore girls often develop vulvovaginitis of a fungal nature.
- During adolescence, the risk of developing vaginal candidiasis increases greatly. This is due to physiological hormonal surges.
- Failure to comply with personal hygiene standards can provoke the growth of candida. This fungus is able to survive not only in the human body, but also in the environment. Together with contact with unwashed hands and insufficiently clean tissues close to the genitals, a large number of pathogens can penetrate into the vagina.
- The fact that candidiasis is contagious remains unresolved. This is due to the fact that the presence of a disease in a sexual partner is not a guarantee that it will develop in a woman. However, sexual contact with an infected man against the background of a weakened female immunity can provoke the development of the disease. If one of the partners is sick, then it is more advisable to conduct treatment in pairs. At the same time, it is better to abandon sexual intercourse for the duration of therapy, and after it ends, use barrier contraception for some time in order to protect against re-infection in case of recurrent thrush.
The disease usually affects the surface layer of the vaginal epithelium. Until the fungal agents are deepened, they can interact quite closely with the rest of the microorganisms. As a result, the further development of the disease is closely related to the state of the vaginal environment and its composition at the microbiological level. Along with the decline in the number of lactobacilli, a chance for reproduction appears not only in fungi, but also in other microorganisms. They can create peculiar associations and even supplant fungal agents or, conversely, help her take a leading position. In approximately 20% of patients, trichomoniasis or gardnerellosis is also detected simultaneously with vaginal candidiasis. If the vaginal dysbiosis is moderate, then the number of lactobacilli can still inhibit the growth of candida, preventing it from penetrating deeper into the mucosa, however, their strength is not enough to completely eliminate the fungal infection. As a result, the body is in a state of some balance that occurs between the fungus and the beneficial flora. As a result, the disease can go in the following ways:
- Candidiasis, which is not a pathology, since it has no negative consequences.
- If the body has sufficient internal strength, then at the expense of its own reserves, it simply restores the normal ratio of microorganisms. In this case, the fungi die and recovery occurs. Such a course is characterized by acute thrush in those women who have strong immunity.
- When the internal resources for the complete extermination of the infection are not enough, but enough to prevent the infection from multiplying for some time, this results in the remission of chronic candidiasis.
- The internal resources of the body are often severely depleted, which aggravates the infectious process and constantly provokes an exacerbation of the disease. Chronic vaginal candidiasis, which is constantly accompanied by relapses, is usually characteristic of women who have not only weakened immunity, but also have an unfavorable gynecological history and extragenital pathology.
Most patients can clearly describe the situation that provoked the development of infection in their case.
Symptoms: how to recognize vaginal candidiasis
As a rule, the disease has characteristic symptoms that can be quite easily recognized. It:
It manifests itself both on the external genitalia and inside the vagina, accompanied by burning and usually intensifies in the afternoon, after the mucous membranes come in contact with water and at night. The severity of the symptom is also facilitated by walking and sexual intercourse. Doctors have a test for thrush: a woman sits in the “foot to foot” position, at this time the itching with candidiasis intensifies. The manifestation of this symptom is also affected by cyclicality: before menstruation, it is more pronounced. It happens that other symptoms of the disease do not appear, but itching itself requires research for the presence of fungal flora.
Of course, women constantly have vaginal discharge, but during the development of a fungal infection, they differ from the norm. At first, there are more of them, and then, with the development of the disease, the discharge also changes its structure. They become like cottage cheese due to the presence of white lumps and flakes in them.
- Pain sensations, urination disorders
Due to the strong inflammatory process that provokes a fungal infection, the mucous membranes of the vulva and urethra also suffer, so pain accompanies urination. Also, due to contact with urine, a burning sensation occurs.
Inflammation leads to the fact that the external genital organs and the vagina swell and swell, and the places of direct introduction into the epithelium of the fungus turn red.
- Discomfort during intercourse
Due to swelling of the mucous membranes, painful sensations are more pronounced, pain and burning accompany sexual intercourse, and in most cases there is no orgasm.
Despite the fact that the symptoms of vaginal candidiasis are quite characteristic, it is impossible to engage in self-diagnosis. The fact is that the disease can occur against the background of more severe infections, and the combined infection is fraught with a lot of threats. In addition, for successful treatment, it is necessary to establish the reason why candidiasis began to develop. Only after its elimination will the disease leave the woman. In nature, there are about 20 species of candida that can provoke symptoms of thrush in the human body. For successful treatment, you need to determine which species caused the disease in order to be able to choose the right drugs. The doctor makes a diagnosis by analyzing data from such sources:
- Clinical picture
- Analysis data.
The history contains information about the patient’s complaints, as well as her assumptions about the cause of the disease and a history of recent illnesses. The clinical picture gives the doctor a high probability to assume that it was the manifestation of vaginal candidiasis that led the woman to the doctor. During the examination, the doctor sees characteristic discharge, a white coating on the mucous membranes. Due to itching, mechanical damage is observed in the form of ulcers, scratching, and wounds. In a smear taken from the vagina, a large number of candida is found (a moderate amount is considered normal). Inoculation is also carried out on a nutrient medium to determine the type of yeast. Additionally, you will need to pass general blood and urine tests, a blood glucose test. If the disease is started, the specialist will recommend visiting an ultrasound room to see how seriously the infection is spread inside, and check the organs for complications.
How is fungal infection treated?
Treatment of vaginal candidiasis should be prescribed only by a specialist. Contrary to the information that we hear on television, this disease is not so easy to get rid of. The treatment has a lot of nuances that only a good gynecologist can know. An important point is the elimination of provoking factors. For this, the patient needs to follow a few simple rules:
- Give up all bad habits
- The patient is shown sexual rest
- Do not take unnecessarily antibacterial and hormonal agents
- Follow the rules of personal hygiene.
It is important to follow a diet during the treatment of vaginal candidiasis. To do this, you need to focus on cereal dishes, as well as eat more vegetables and fruits. It is useful during this period to drink yoghurts, kefirs, starter cultures based on beneficial bacteria to restore microflora. However, it is better to temporarily exclude some products:
- Bakery products
- Smoked meats
- Spicy and highly seasoned dishes
- Milk products.
If you follow this simple diet, then recovery comes much faster. Hygiene procedures must be performed with great care. It is better if the woman will wash herself twice a day. Douching is contraindicated. Do not use aggressive hygiene products for washing. You can use a solution of soda to reduce acidity, a slightly pink manganese solution in order to dry mucous membranes, as well as decoctions and infusions of chamomile, barberry, calendula, and cloves. By the way, chamomile is also good for ingestion (like a herbal tea). After water procedures, you need to blot the external genitals with a clean, specially designed towel or pharmacy napkins. Linen should be worn only clean, made from natural fabrics, it should not be tight, like the clothes themselves.
Topical treatment of vaginal candidiasis
If thrush bothers a woman for the first time, then the infection reacts to local therapy. They produce drugs for external use in the following forms:
- Vaginal suppositories
- Vaginal tablets
Local treatment has many advantages, since the effect on the fungus is carried out directly in the place where the infection has settled, then they do not have a negative effect on the body. The therapeutic effect of this interaction is quite strong, therefore, local drugs quickly relieve the patient of the manifestations of candidiasis. It is convenient and easy to apply. Most popular now:
The course of treatment ranges from a week to a month, depending on the drug and the severity of the disease. But drugs for external use are in most cases single-component, and this leads to the fact that they cannot cope with an infection that has managed to take root.
Systemic treatment of thrush
Where local therapy is not effective enough, reinforcement in the form of systemic drugs is required. They are available in the form of tablets or capsules. Oral antifungal agents attack the fungus from the inside, but at the same time they have a large number of contraindications, so their intake should be carried out under the supervision of a specialist. Most of the pills for thrush are developed on the basis of Fluconazole. A single dose of 150 mg of the drug is enough to help the body cope with the infection, but there are times when the drug is extended to 3-4 weeks (the dose is the same, taken once every seven days). Intraconazole is considered an alternative to Fluconazole. Its dosage is slightly higher, and the doctor determines the intensity of the course individually. Also in the treatment of fungal infections for oral administration, Nystatin and Levorin (these are antibiotics) are suitable. Acute thrush, subject to timely treatment, takes place after a week, but the treatment of the chronic form of the disease is more difficult, after getting rid of the symptoms for three months, control is performed to avoid new outbreaks. It is impossible to stop treatment when the symptoms disappear, you need to bring the course to the end – this will avoid complications. If you are worried about vaginal candidiasis, and you do not know how to cope with the problem, or have doubts, write to our specialist and get a detailed qualified answer as soon as possible.