Vulvovaginal pseudomycosis
Vulvovaginal pseudomycosis was once called mycosis fungoides, and its pathogenic bacteria are yeasts mainly Pseudomonas albicans, with others such as smooth Pseudomonas, Pseudomonas tropicalis, and Pseudomonas subsmoothis accounting for a minority.
I. Classification of vulvovaginal pseudomonal yeast
Vulvovaginal pseudofilamentous yeast is divided into simple and complex. Simple is mild or moderate occurring in normal non-pregnant hosts, disseminated, and caused by Pseudomonas albicans.
Complex Pseudomonas vulvae includes: recurrent Pseudomonas vulvae, severe Pseudomonas vulvae, Pseudomonas vulvae during pregnancy, Pseudomonas vulvae not caused by Pseudomonas albicans, or with an uncontrolled diabetic, immunocompromised host.
Severe vulvovaginal pseudofilamentous yeast is defined as severe clinical symptoms, with breakage of the vulvar or vaginal skin mucosa, and a score of 37 as severe vulvovaginal pseudofilamentous yeast according to the vulvovaginal pseudofilamentous yeast scoring criteria. Recurrent vulvovaginal pseudofilamentous yeast refers to women with vulvovaginal pseudofilamentous yeast who, after treatment and disappearance of clinical symptoms and signs and negative fungal tests, develop symptoms again and have positive fungal tests and have four or more episodes in a year.
II. Diagnosis of vulvovaginal pseudofilamentous yeast
1.Clinical manifestations
Symptoms: itching and burning pain in vulva, also accompanied by painful urination and painful intercourse; increased leucorrhea.
Signs: flushing and edema of vulva, scratching or cracking, white membranous material attached to the inner labia minora and vaginal mucosa, more white bean curd-like secretion in the vagina, which may be curd-like.
2.Laboratory examination
Suspension method: 10% KOH microscopic examination, the positive rate of mycelium is 70%-80%. The physiological saline method has a low positive rate and is not recommended.
Smear method: microscopic examination by gram stain, the positive rate of bacteriophage 70%-80%.
Culture method: RVVC or those with symptoms but multiple negative microscopic examinations should be diagnosed by culture method with drug sensitivity test.
III. Treatment of vulvovaginal pseudofilamentous yeast
Treatment principles.
1.Actively remove the causative agent of vulvovaginal pseudomonal yeast.
2. Standardize the application of antifungal drugs. The first episode or the first visit is the key period for standardized treatment.
3. Sexual partners do not need routine treatment; the patient’s sexual partners should be examined at the same time and given treatment if necessary.
4.Vaginal douching is not routinely performed.
5.Avoid sexual intercourse or condom use during the acute period of vulvovaginal pseudomonal yeast.
6. Treat other sexually transmitted infections at the same time.
7.Emphasize individualization of treatment.
8, Long-term oral antifungal drugs should be monitored for liver and kidney function and other related toxic side effects.
Antifungal treatment.
1.Treatment methods include vaginal medication and oral medication.
2.Treatment plan
Simple vulvovaginal pseudomycetes
Vaginal medication is preferred and any one of the following regimens is chosen, as follows.
Vaginal medication
Miconazole suppository 1200mg, single dose.
Miconazole suppository 400mg once a night for 3 days.
Miconazole suppositories 200mg, once a night for 7 days.
Clotrimazole suppository 500mg, single dose.
Clotrimazole suppository 100mg, once a night for 7 days.
Mycoplasma effervescent tablets 100,000 U once a night for 14 days.
Oral medication
Fluconazole: 150mg, once a day.
Severe vulvovaginal pseudomelanosis.
Oral medication is preferred. For severe symptoms, topical application of low concentration glucocorticoid ointment or azole cream.
Fluconazole: 150 mg in a single dose, applied on days 1, 4 and 7.
Vaginal medication, which should be based on the treatment of simple VVC regimen, should be extended.
Other drugs available are Itraconazole, but a 5-7 day course is recommended in the treatment of severe VVC.
Pseudomonas vulvae during pregnancy.
Weigh the pros and cons of using medications carefully during early pregnancy. Choose vaginal medications that are not harmful to the fetus rather than oral antifungal therapy. The specific regimen is the same as for simple Pseudomonas vulvae, but the longer regimen is more effective than the shorter regimen.
Recurrent vulvovaginal pseudomonal yeast.
Treatment principles include intensive and consolidation therapy. Drug selection is based on culture and drug sensitivity testing. After intensive treatment to achieve fungal cure, consolidation therapy is given for up to six months. The following regimen is for information only.
Intensive treatment: either oral or topical regimen, as follows
Oral medication.
Fluconazole 150 mg, administered in a single dose on days 1, 4 and 7.
Vaginal medication
Miconazole suppository 400mg once a night for 6 days.
Miconazole suppositories 1200mg, applied on days 1, 4 and 7.
Clotrimazole suppository 500mg, repeated after three days.
Clotrimazole suppository 100mg, once a night for 7 to 14 days.
Consolidation therapy: Given that there is no mature program in China or abroad.