Noninvasive Oral and Vaginal Candidiasis Flashcards by Linda Chen

what happens to a healthy vaginal when balance of organisms is disrupted

overproduction or colonization can occur

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what is the most prominant time of vaginal discharge

mid cycle around time of ovulation

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normal vaginal discharge is (amount, scent, colour)

scant, odorless, and clear/ whitish

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3 most common causes of vaginal infections characterized by discharge and vulvovaginitis

BV
trichomoniasis
VVC (yeast infection)

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describe the common symptoms of VVC

Severe itching in vulva + vaginal area +/- Stinging and burning
Cottage cheese discharge

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what pH is VVC

<4.5

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describe the common sx of lactobacillosis

Itching of vaginal or vulva area +/- Burning of vulva (mimics UTI)
White or yellowish vaginal discharge (varies in consistency)
Cyclic sx: 2nd half of menstrual cycle, peaks shortly before menses

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what pH is lactobacillosis

3.5-5.5

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describe the common sx of BV

Fishy odor
Creamy discharge (yellow-gray)

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bacterial vaginosis pH

5-6

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BV is most commonly due to

polymicrobial infections

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trichomoniasis sx

Frothy, wet discharge +/- Possibly itchy

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trichomoniasis pH

->6

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which of the following is sexually transmitted
1. VVC
2. lactobacillosis
3. BV
4. trichomoniasis

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VVC is cased by the overgrowth of

candida albicans

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what is the prevalence of VVC

~75% of persons with a vaginal will experience at least 1 episode of VVC in their lifetime
Dramatic ↑ in freq of VVC once one becomes sexually active + ↑ risk with oral-genital contact

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what are the 4 criteria for uncomplicated VVC

Sporadic or infrequent
Mild-mod sx or findings
Candida albicans infxn (suspected or proven)
Non Immunocompromised

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what are the 4 factors that could indicate complicated VVC

Recurrent (4 or more episodes/ yr)
Severe sx or findings
Nonalbicans candida
Those with diabetes, immunocomp conditions, or immunosuppressive tx

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list 3 predisposing factors for VVC

Pregnancy
Medications (abx, corticosteroids, chemo, hormone therapy, oral contraceptives, levonorgestrel IUD, tamoxifen)
Contraceptives (spermicide, sponge, diaphragm)
DM
Immunocompromised conditions
Diet (excess refined carbohydrates)
Chemical irritants (antiseptics, deodorants, sprays, soaps), douching
Stress
Menses
Synthetic undergarments
Tight fitting clothing

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list 3 circumstances where you should refer for VVC

Pregnant
Prepubertal (VVC not common)
Presents with vaginal sx for 1st time = refer to MD for testing
Recurrence of VVC within 2 mths of last episode
Immunosuppressed
Underlying illness such as DM
Risk of STI (ex- hx unprotected intercourse, multiple partners, casual sexual encounters)

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list 2 nonpharm measures in treating VVC

No spec nonpharm tx but preventative measures are suggested for avoiding recurrences
Good hygiene
Avoid vaginal deodorants, douches, harsh soaps, perfumed products
Avoid tight clothing and synthetic underwear
Diet mods? (incons evidence with lactobacillus in yogurt, no data for yeast or sugar free diets)

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T or F: diet modifications like including yogurt and decreasing yeast or sugar intake may decrease VVC recurrence

F- inconsistent/ no data

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T or F: asymptomatic VVC does not need to be treated

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selection of products for uncomplicated VVC should be based on

patient preference

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describe the difference between VVC OTC treatments

1, 3, 6, 7 day products- all have the same efficacy (Difference = concentration) 1 day = shorter duration but higher concentration = ↑ risk AEs (irritation, burning) no stat difference in efficacy between oral vs intravaginal or among topical azole agents

what 2 topical imidazoles are available nonRx in canada

Clotrimazole (creams, tabs) and miconazole (creams, ovules, suppositories)

what is a nonRX PO option for VVC

fluconazole

what is a topical prescription product for VVC

terconazole

common AEs to topical VVC tx

burning, redness, irritation, stinging, itching Switching brands may alleviate this SE

terconazole HC safety warning includes

anaphylaxis and TEN have been reported- d/c tx if anaphylaxis or TEN develops

which of the following is not information you should counsel your patient on about topical azoles for VVC 1. it may be used at any point in the menstrual cycle, even during bleeding 2. tampons may help keep the cream or ovule within the vaginal canal, enhancing absorption 3. topical and intravaginal azoles can be used concomitantly 4. should be applied at bedtime to increase contact time with vaginal tissues 5. all of the above are valid counselling points

2- avoid tampons as they can absorb the med + cause fungus growth

3 possible interactions of topical azoles

miconazole with warfarin- can increase INR may decrease effects of vaginal progesterone = avoid concomitant use ovules may decrease effectiveness of condoms and diaphragms

what is the oral fluconazole dose for uncomplicated VVC

150mg PO F1D

AEs of oral fluconazole

N/V/D, cramping, HA

oral fluconazole is not recommended in

<12yrs, pregnancy (consider alternatives + use caution)

VVC symptoms being treated with fluconazole should completely resolve by

day 7

why is caution recommended with fluconazole during pregnancy

↑ risk of spontaneous abortion 1st trimester high dose = ↑ risk of cardiac septal closure anomalies 1st trim =↑ risk of congenital malformations + sig ↑ risk of spontaneous abortions

severe VVC sx

extensive vulvar erythema, edema, excoriation of fissure formation

tx for severe VVC

Fluconazole 150mg PO q72h F2 doses or Intravaginal azole (same as uncomplicated) F10-14d

what is induction tx for complicated or recurrent VVC

Fluconazole or intravaginal azole + boric acid fluconazole 150mg PO F3 doses topical azole F10-14d boric acid 300-600mg gelatin capsule intravaginally daily F14d

boric acid is CI in

pregnancy

boric acid SEs

local irritation, vaginal burning, more pronounced with higher doses

how is boric acid used in complicated or recurrent VVC

300-600mg compounded gelatin capsule intravaginal once daily F14d

what is maintenance tx for complicated/ recurrent VVC

Fluconazole 150mg PO qwk or Clotrimazole 500mg intravaginally qmth or Boric acid 300mg capsule intravaginally F5d/mth- Start 1st day of cycle Duration = minimum 6mths

T or F: sexual partners of a patient with VVC should be treated if they are uncircumcized

F- only tx if symptomatic or balanitis or partner has recurrent infections

what is balanitis?

inflammation on glans of penis + pruritus or irritation

how should you treat balanitis

Topical azole 1-2x/d F7d or oral fluconazole 150mg PO single dose

what is the evidence about probiotic use in VVC/ - overall quality - ST effects - LT effects - interactions

Overall evidence quality low/ v low may be used adj to antifungals to enhance ST effects / relapse doesn't influence LT effects no interference with tx but combo unlikely to reduce occurrence of VVC

what is oral candidiasis

mucocutaneous opportunistic infxn caused by candida species

what is the most common fungal infection in both immunocompetent and immunocompromised pts

oral candidiasis

list 3 disease RFs for oral candidiasis

addison disease, anemia (iron, folic, B12), DM, HIV, hypothyroidism, leukemia, head and neck cancer, psoriasis, xerostomia

list 3 meds that are Rfs for oral candidiasis

broad spectrum abx (normal usually ok), chemo, immunosuppressive drugs, inhaled CS

list 3 RFs for oral candidiasis that are not disease states or meds

infants/ children, local mucosal trauma, poor dental hygiene, pregnancy, smoking, surgery

what is the classic marker of oral candidiasis

easy to wipe off plaques leaving behind erythematous surface

what are some sx of oral candidiasis

white plaque on tongue, buccal mucosa, hard palate, soft palate, and oropharynx

oral candidiasis is typically 1. asymptomatic 2. resulting in white powder on back of throat that does not wipe off 3. transmitted through oral-genital contact 4. none of the above

pts with symptomatic oral candidiasis may have

burning sensation or changes in taste

2 pharm tx for oral candidiasis

topical nystatin oral suspension fluconazole

how should adults use topical nystatin oral syspension

400,000-600,000 (~4-6mL of 100,000 unit suspension) units QID (swish and swallow) F7-14d

how to tx infant thrush with topical nystatin oral suspension

100,000 units (1mL) in each side ofmouth QID F7-14d In BF infant- consider topical tx nipple (clotrimazole, nystatin, miconazole- but lacks safety data- refer for assessment of latching + possible dual tx)

which is preferred for initial or mild cases of oral thrush 1. nystatin oral suspension 2. fluconazole

fluconazole is 2nd line for oral candidiasis due to

azole resistant candidiasis strains

fluconazole is used in oral candidiasis for _______ and _____________

`mod-severe disease preventative tx for recurrent infections

describe the 5 counselling points for topical nystatin

Shake bottle well before you measure each dose Swish nystatin around mouth then swallow liquid. Retain in mouth for as long as possible (ex- several minutes if possible) Do not eat/ drink anything for 5-10+ minutes after each dose Try to brush teeth 20-30 min after taking nystatin (contains sugar) + brush at least BID (esp before bed) Avoid concomitant topical use with chlorhexidine (ex- denture wearers) as it will negate effect

improvement in oral thrust should be seen within

2-3 days

once antifungal tx has been started for oral candidiasis, advise pt to monitor symptoms on a daily basis _______ and for up to ________________

daily basis during tx up to 2 weeks after clearing of sx

Noninvasive Oral and Vaginal Candidiasis Flashcards

(66 cards)