[9] Vulvovaginal Candidiasis Flashcards

1
Q

What is vulvovaginal candidiasis?

A

A fungal infection of the lower female reproductive tract

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2
Q

What is vulvovaginal candidiasis more commonly known as?

A
  • Thrush

- Yeast infection

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3
Q

When does the prevalence of vulvovaginal candidiasis peak?

A

20-40 years old

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4
Q

What proportion of the female population will experience vulvovaginal candidiasis at least once?

A

Most

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5
Q

What is the causative organism in 90% of vulvovaginal candidiasis cases?

A

Candida albicans

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6
Q

Where is candida albicans found?

A

As part of the body’s normal flora in the GI tract

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7
Q

How does candida albicans replicate?

A

Budding

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8
Q

What can occur as a result of candida albican existing as part of the normal GI flora?

A

Oral candidiasis can occur in men and women

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9
Q

What is candidiasis traditionally thought of as?

A

Opportunistic infection

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10
Q

What is an opportunistic infection?

A

One that exploits opportunities of weakened host e.g. compromised immune system or altered microbiota

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11
Q

What is no thought to contribute to vulvovaginal candidiasis?

A
  • Hypersensitivity reaction to candida albicans
  • Genetics
  • Oestrogen levels
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12
Q

What % of women may carry candida albicans asymptomatically?

A

20%

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13
Q

What are the risk factors for vulvovaginal candidiasis?

A
  • Pregnancy
  • Diabetes
  • Use of broad spectrum antibiotics
  • Use of corticosteroids
  • Immunosuppression or immunocompromisation
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14
Q

Why can broad spectrum abx lead to vulvovaginal candidiasis?

A

They can alter the normal vaginal flora allowing candida albicans to overgrow

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15
Q

How can corticosteroids use lead to vulvovaginal candidiasis?

A

It has an immunosuppressive action

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16
Q

Who can be at risk of vulvovaginal candidiasis due to immune system reduction?

A
  • HIV patiens

- Cancer patients

17
Q

What can occur to patients who are immunosuppressed/compromised who have vulvovaginal candidiasis?

A

Can lead to life-threatening infection

18
Q

What are the symptoms of vulvovaginal candidiasis?

A
  • Pruritus vulvae
  • Vaginal discharge
  • Dysuria
19
Q

What are the examination findings in vulvovaginal candidiasis?

A
  • Erythema and swelling of the vulva
  • Satellite lesions
  • Curd-like discharge in vagina
20
Q

What are the satellite lesions seen in vulvovaginal candidiasis?

A

Red pustular lesions with superficial white/creamy pseudomembranous plaques that can be scraped off

21
Q

What are the differentials for vulvovaginal candidiasis?

A
  • BV
  • Trichomoniasis
  • STI
  • Atrophic vaginitis
  • Lichen sclerosis
  • Contact dermatitis
  • Eczema
  • Psoriasis
  • Recto-vesical fistula
  • UTI
22
Q

What is an important underlying disorder to rule out when presented with vulvovaginal candidiasis?

A

DM

23
Q

What investigations are needed to diagnose vulvovaginal candidiasis?

A

None if the history indicates an acute uncomplicated case

24
Q

What investigation can be undertaken if examining a woman for vulvovaginal candidiasis?

A

pH

25
Q

What is defined as an acute uncomplicated case of vulvovaginal candidiasis?

A
  • Sporadic
  • Mild to moderate symptoms
  • No risk factors
26
Q

What tests should be carried out in complicated cases of vulvovaginal candidiasis?

A
  • Vaginal smear

- Microscopic investigation

27
Q

What features of microscopy are indicative of vulvovaginal candidiasis?

A
  • Spores

- Mycelia

28
Q

What advice should be given to people with vulvovaginal candidiasis?

A
  • Use a soap substitute to clean
  • Use emollient
  • Wear loose fitting clothes
  • Good hygeine
29
Q

What should be prescribe for a single episode of vulvovaginal candidiasis?

A

Intravaginal antifungal e.g. clotrimazole or oral antifungal e.g. fluconazole

30
Q

Where can antifungals for vulvovaginal candidiasis be obtained?

A

OTC

31
Q

What is important to keep in mind when using topical treatments for vulvovaginal candidiasis?

A

They can weaken latex condoms

32
Q

After what period of no response to treatment should women return?

A

7-14 days

33
Q

What should be considered if vulvovaginal candidiasis does not respond to treatment?

A
  • Alternative diagnosis
  • Predisposing risk factors
  • Patient’s concordance with medication
34
Q

What should be performed if considering alternative diagnosis for vulvovaginal candidiasis?

A
  • Vaginal pH

- Vaginal swab for microscopy and culture

35
Q

When should vulvovaginal candidiasis be referred to a specialist?

A
  • If non-albicans Candida species

- No symptom resolution

36
Q

How should severe cases of vulvovaginal candidiasis be treated?

A

3 doses of oral fluconazole 3 days apart

37
Q

How are oestrogen levels thought to increase risk of vulvovaginal candidiasis?

A
  • By stimulating increased glycogen production providing a more favourable environment for candida growth
  • Directly promoting growth and adherence of candida
38
Q

What is the result of oestrogen promoting candida growth?

A

Increased risk of vulvovaginal candidiasis in pregnancy

39
Q

How should vulvovaginal candidiasis be managed in pregnancy?

A
  • Treat with intravaginal antifungal
  • Don’t give oral antifungals
  • Treat vulval symptoms with topical antifungals
  • Be careful when inserting intravaginal applicator
  • Ensure history is not suspicious for STI
  • Advise to return if not resolved in 7-14 days