Monilial vaginitis (Vaginal candidiasis) incidence:
* Represent 30% of causes of vaginitis (The 2nd most common).
* Present in 20% of pregnant women.
Monilial vaginitis (Vaginal candidiasis) aetiology:
♦♦♦ Causative organism:
* Candida albicans (90% of cases): (With pseudohyphae & reproduce by budding).
* Others: candida tropicalis, Glabrata, and Krusei.
♦♦♦ Rout of infection:
* Sexual route: from diabetic partner i.e. diabetic balanitis.
* Non-sexual routes:
– Exacerbation of a carrier state.
– Infected towels & toilet seats.
– Infection from intestinal candidiasis.
♦♦♦ Predisposing factors:
* These factors share high vaginal acidity, rich carbohydrates & lowered immunity.
– Pregnancy & high dose COCS.
– DM & immunosuppressive states.
– Prolonged antibiotic therapy & prolonged corticosteroid therapy.
– Excess humidity.
Monilial vaginitis (Vaginal candidiasis) diagnosis:
* Rare in child and old age (estrogen dependent infection).
* Most cases are premenstrual (high acidic medium)
♦♦♦ Symptoms:
– Pruritus vulvae: main complaint & not related to amount of discharge.
– Discharge: * white, curdy, thick, and scanty,
* Odorless (may be yeasty), or offensive in mixed infection.
– Pain & soreness of vulva: secondary vulvitis.
– Dyspareunia: due to tender vagina.
– Frequency & burning micturition.
♦♦♦ Signs:
– Vulva: Red & tender with scratching marks.
– Vagina: White patches adherent to the vaginal wall.
Monilial vaginitis (Vaginal candidiasis) investigations:
♦♦♦ Diagnosis of the disease:
– Fresh drop examination (wet film):
* Drop of discharge is mixed with drop of saline on a slide & examined: shows no movement.
* KOH can be used to kill all cells except candida.
– Stained film:
* Methylene blue: to see the organism.
* Gram stain: Gram +ve & violet.
– Culture: on Nickerson’s medium.
– PH: 3.5 – 4.5 (> 4.5 excludes candida).
♦♦♦ For predisposing factors: blood glucose for DM.
Monilial vaginitis (Vaginal candidiasis) treatment:
♦♦♦ General measures:
– Control predisposing factors e.g. DM.
– Vitamin B complex: ↓growth of monilia.
– Local hygiene; shaving hair, keep dry, change clothes.
– Cotton made underwear and should be boiled.
– Vaginal douches alkaline e.g. NaHCO3 or antiseptic povidone iodine.
♦♦♦ Local :
* Imidazole derivatives (given for 5 days).
– Miconazole: gynodactrin cream.
– Tioconazole: gynotrosyd vaginal pessary.
– Clotrimazole: canesten vaginal pessary & cream.
* Nystatin:
– Mycostatin vaginal pessary & cream.
– Twice daily for 2 weeks, then
– Once daily for another 2 weeks.
♦♦♦ Systemic treatment:
* Imidazole derivatives:
– Ketoconazole: 200 mg bid for 5 days.
– Fluconazole: 150 mg single dose.
– Itraconazole.
* Nystatin:
– Mycostatin: 100o, 000 units’ tid for 7 days in cases of intestinal candidiasis.
Recurrent moniliasis
Recurrent moniliasis definition:
Four attacks or more of monilial infections in one year.
Recurrent moniliasis aetiology:
* Prolonged antibiotic therapy is the main cause.
* Persistent source of infection e.g. – Intestinal candidiasis,
– Organism under nails.
* Persistent source of infection e.g. – Infected sexual partner.
* Persistent predisposing factors e.g. – Uncontrolled D.M.
Recurrent moniliasis investigations:
* Culture is mandatory to detect non-albicans species & HPV.
Recurrent moniliasis treatment:
* Correction of predisposing factors.
* Long oral low dose course of Imidazole derivative;
– e.g. Fluconazole 50 mg once weekly for 3-6 months.