Professional Documents
Culture Documents
J. D. Sobel MD
Basics
Description
Yeast vulvovaginitis usually presents as an acute inflammation of both vagina
and vulva almost always caused by Candida species and rarely by nonCandida organisms
Symptoms and signs vary from mild, moderate, to severe, with infrequent
attacks in some women and recurrent attacks in others (4 attacks/per year).
Alert
Pediatric Considerations
Because Candida species depend on estrogen to alter vaginal epithelium and bacterial
flora, VVC is extremely rare in prepubertal girls. Most episodes of vulvar pruritus and
inflammation in children are NOT due to yeast.
Geriatric Considerations
Attacks of VVC likewise diminish in postmenopausal women not receiving HRT.
Epidemiology
~75% of women will develop at least 1 lifetime episode, 1/2 of whom subsequently
have >1 attack.
Pathophysiology
Microbiology
Any Candida species may cause symptomatic vulvovaginitis, however >90%
due to C. albicans.
Non-albicans species (C. glabrata, C. parapsilosis, C. tropicalis) are less
frequent pathogens and also less virulent, more likely to simply colonize
vaginal secretions and serve as innocent bystanders.
Pathogenesis
Pathogenesis of VVC is complex and multifactorial in etiology.
Risk Factors
Risk factors exist for colonization as well as for transformation from
colonization to frank acute symptomatic vulvovaginitis.
Risk factors for vaginal colonization include:
o
Diagnosis
Signs and Symptoms
History
Vulvovaginal pruritus is almost invariably present
Other manifestations of inflammation include:
o
Irritation
Soreness
Burning
Physical Exam
Signs include:
o Vulva:
Tests
Lab
Erythema
Edema
Excoriation
Fissure formation
Vagina:
Erythema
Edema
None of the symptoms and signs is specific and diagnosis cannot be made by
exam alone.
Saline microscopy:
No increase in PMNs
Always positive
Nonculture confirmation:
o
P.209
Differential Diagnosis
Easy to differentiate from other infectious causes of vaginitis (i.e., bacterial
vaginosis, trichomoniasis, cervicitis), because all have increased pH (>4.5)
Most important alternative diagnosis of normal pH vulvovaginitis is:
o
Treatment
General Measures
Decide whether patient has uncomplicated or complicated Candida vaginitis.
Most patients have uncomplicated VVC characterized by mild or moderate
disease caused by C. albicans, with no tendency to a recurrent pattern, are
immunocompetent.
o Uncomplicated VVC requires short-course (including single-dose)
therapy for clinical cure.
Medication (Drugs)
Intravaginal agents:
o Butoconazole 2% cream 5 g intravaginally for 3 days*
Oral agent:
o
Trial of boric acid vaginal capsules 600 mg/d (cure rates ~70%)
Followup
None required
HIV testing is not required.
Bibliography
Centers for Disease Control and Prevention. Sexually transmitted disease treatment
guidelines 2006. MMWR Morb Mortal Weekly Rep. 2006;(55).
Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:19611971.
Miscellaneous
Synonym(s)
Candida vaginitis
Fungal vaginitis
Monilial vulvovaginitis
Vaginal candidiasis
Vulvovaginal candidosis
Yeast vaginitis
Yeast vulvitis
Clinical Pearls
Ready access to over-the-counter antifungal agents is associated with wasted financial
expenditures, unfulfilled expectations, and a delay in correct diagnosis.
Abbreviations
HRTHormone replacement therapy
PCRPolymerase chain reaction
PMNPolymorphonuclear leukocytes
VVCVulvovaginal candidiasis
Codes
ICD9-CM
112.1 Candidal vulvovaginitis