1. What are the signs of mycosis vaginalis? How do I check for it?
Candida vaginitis typically manifests itself with itching and tofu-like leucorrhea, and the itching can sometimes be very intense or even fidgety. However, there are some non-Candida albicans infections that do not have typical symptoms and sometimes only show increased leucorrhea or mild itching. The test for Candida vaginitis is relatively simple. Routine tests of the leukorrhea combined with symptoms can basically diagnose the disease, usually in symptomatic patients when pseudofilaments are seen under the microscope. It is important to note that a fungal culture is not usually required and a positive fungal culture does not necessarily lead to a diagnosis of Candida vaginitis. Fungal cultures are usually used in patients with recurrent episodes. The main value of the culture is to know which Candida is causing the infection. The results of the drug sensitivity test do not necessarily correlate with the in vivo treatment effect of the drug, so the drug selection cannot be based solely on the drug sensitivity test.
The symptoms are similar to those of Candida vaginalis, which can be itchy or have a pea-like discharge. If the patient has symptoms of Candida vaginitis but often the fungal mycelium cannot be found in routine white belt tests, this disease needs to be considered.
2. Why is “mycotic” vaginitis prone to recurrence?
Candida can be present in the vagina of normal people and does not develop under normal immune or vaginal conditions. However, when there are certain triggering factors, such as local vaginal micro-ecological changes, broad-spectrum antibiotics, decreased immunity or hormone use, it is easy to have an attack.
3. How is mycotic vaginitis treated medically?
The treatment of common Candida vaginitis is not complicated, especially for the first episode, and does not require special stress. Candida, especially the common Candida albicans, has very few drug-resistant strains, so almost all commercially available vaginal antifungal drugs are effective. Medications can be either vaginal or oral, with miconazole, clotrimazole, mycophenolate, amphotericin, etc. common for vaginal plugs, and Daflucan and Spiramycin for oral use. There are different ways to use drugs depending on the dosage form or category, such as Kenitin, which can be inserted vaginally 1-2 times with an interval of 3-7 days, while most of the drugs used once a day have a course of treatment of about 7 days. Oral medications such as Daflucan are generally 150mg and can be taken once orally. In severe or complicated cases of Candida vaginitis, the duration of the medication is doubled, but usually it does not exceed 2 weeks of medication. If the symptoms disappear, a review is not always necessary. Special attention should be paid to the first episode of Candida vaginitis, which does not require long-term medication and douching is not recommended to avoid damaging the local vaginal environment and causing a decrease in resistance.
More complicated is recurrent Candida vaginitis, which is usually defined as Candida vaginitis that occurs four or more times a year. For this type of vaginitis, it is important to go to the hospital for a standardized evaluation, including medical history, fungal culture, screening for immune-related diseases such as AIDS and diabetes, high-risk factors such as long-term antimicrobial use, high-dose estrogen use, oral contraceptive use, immunosuppressant use, and, if necessary, vaginal microecological evaluation. Based on careful evaluation, all high-risk factors or disease-related factors are removed and corrected, followed by standardized treatment, which usually takes more than 6 months. Sexual partners usually do not need to be treated at the same time, but if the disease is clearly related to sex or if the partner has symptoms, the partner should be treated as well.
4. How do I use suppositories for mycotic vaginitis?
Pregnant women are susceptible to Candida vaginitis because of the local vaginal environment and immune function. Candida vaginitis in pregnant women is usually treated with vaginal suppositories instead of oral antifungals. The safer one to use during pregnancy is Kenitin. The main purpose of using antifungals during pregnancy is to control symptoms, and it is not necessary to have a fungal conversion if symptoms are not significant and medication is not effective.
A proportion of virgins also get Candida vaginitis and the treatment regimen is similar to that of non-virgins. Medications can be used orally or as vaginal suppositories. Most hymens have a middle hole and most can fit more than one finger through, so most medications can be inserted. However, if a virgin needs a vaginal plug it is recommended that it be used under medical supervision. The use of oral medications is the same as for non-virgins.
Most medications commonly used clinically for the treatment of Candida vaginitis have mild side effects. Oral medications are mainly associated with liver impairment and vaginal suppositories are mainly associated with local irritation. Any drug-related discomfort requires prompt consultation with a physician. Whereas oral antifungal drugs, especially long-term use of oral antifungal drugs requires assessment of liver function.
5. What is used to cleanse the vagina for “mycotic” vaginitis?
Vaginal douching is generally not recommended for the treatment of Candida vaginitis. Some patients who are particularly difficult to treat may consider using boric acid lotion.
6. Can I wash my vagina during pregnancy?
Vaginal douching is not recommended during pregnancy.
7. What is the difference between several antibiotics for bacterial and fungal vaginitis?
The most common antibiotic used in gynecology to treat bacteria is metronidazole, which is ineffective against fungi, and Lactobacillus, which is naturally resistant to metronidazole as a normal flora, so metronidazole is the drug of choice for vaginitis or vaginosis caused by anaerobic bacteria. All other types of antibiotics generally require careful evaluation and a clear purpose for use if they are needed for vaginitis. Commonly used drugs for vaginal fungal infections are Daflucan and Spironolactone, but of course other antifungal drugs are also available, which are usually ineffective against common bacteria.
8. What should I do if I am uncomfortable after using medication for “mycotic” vaginitis?
Some patients may experience local irritation or abnormal discharge after vaginal medication for Candida vaginalis. If you feel that your symptoms are serious, you need to see your doctor for an evaluation to decide whether to continue the medication.
9. Can I use Lactobacillus supplementation for “mycotic” vaginitis?
There is no good evidence that Candida vaginitis is associated with a deficiency of Lactobacillus. However, it is worth noting that some of the recurrent fungal vaginitis have a history of long-term antibiotic use or the use of broad-spectrum antibiotics may trigger the onset of Candida vaginitis, so it is reasonable for some selective patients to be treated with Lactobacillus supplementation along with antifungal therapy. However, the course and duration of Lactobacillus supplementation is not well documented and evidenced. There is also a lack of mature, effective lactobacillus supplementation drugs.
10. How can I prevent transmission of mycotic vaginitis?
Transmission of fungal vaginitis is not a major problem because most Candida vaginitis is endogenous, as Candida in the vagina, mouth and intestines can be transmitted to each other. And Candida can also be present in the body as normal flora. However, there are some cases of Candida vaginitis that can be transmitted sexually or through indirect contact, so appropriate precautions need to be developed to prevent contact or treat sexual partners in patients with suspected sexual or contact transmission.