A 35-year-old woman presents with severe vaginal and vulvar itching. She also complains of a thick white discharge. Figure 85-1 demonstrates the appearance of her vulva and introitus, and Figure 85-2 shows her cervix. Figure 85-3 shows the wet prep with pseudohyphae. Treatment with a nonprescription intravaginal preparation was successful.
Candida on the vulva and introitus showing whitish patches with erythema. (Reproduced with permission from Richard P. Usatine, MD.)
Candida vaginitis visible on the cervix. Note the thick white adherent "cottage-cheese-like" discharge. (Courtesy E.J. Mayeaux, Jr., MD.)
Wet mount with KOH of Candida albicans in a woman with Candida vaginitis. Seen under high power demonstrating branching pseudohyphae and budding yeast. (Reproduced with permission from Richard P. Usatine, MD.)
Vulvovaginal candidiasis (VVC) is a common fungal infection in women of childbearing age. Pruritus is accompanied by a thick, odorless, white vaginal discharge. VVC is not a sexually transmitted disease. On the basis of clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated.1 Uncomplicated VVC is characterized by sporadic or infrequent symptoms, mild-to-moderate symptoms, and the patient is nonimmunocompromised. Complicated VVC is characterized by recurrent (four or more episodes in 1 year) or severe VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression.1
Yeast vaginitis, yeast infection, candidiasis, moniliasis.
VVC accounts for approximately one third of vaginitis cases.1
Candida species are part of the lower genital tract flora in 20% to 50% of healthy asymptomatic women.2
VVC is most common in reproductive-age women and is uncommon in postmenopausal women. Seventy-five percent of all women in the United States will experience at least one episode of VVC. Of these, 40% to 45% will have two or more episodes within their lifetime.1 In patient surveys, 29%–49% of premenopausal women report having had at least one lifetime episode of VVC, and 55% of female university students report having had at least one healthcare provider–diagnosed episode by age 25 years.3
It is a frequent iatrogenic complication of antibiotic treatment, secondary to altered vaginal flora (Figure 85-4).
Recurrent vulvovaginal candidiasis (RVVC) is defined as four or more episodes of symptomatic VVC in 1 year. Nine percent of women report having had RVVC. In women with an initial infection, the probability of RVVC was 10% by age 25 years, and 25% by age 50 years.4 Recurrent yeast vaginitis is usually caused by relapse, and less often by reinfection. ...