Mycosis fungoides or Candida vaginitis, or vulvovaginal pseudofilamentous candidiasis (VVC), is a common and frequent inflammatory disease of the vulva and vagina caused by Candida albicans. The main symptom is itching, which is sometimes mild and sometimes severe. In severe cases, the itching is unbearable and the restlessness seriously affects women’s work life. The leukorrhea is usually thick, bean-like or milky clot-like. It is called simple VVC when it occurs only once, but some patients have recurrent symptoms that can last for many years, and it is called complicated VVC when it is unbearable.
Mycotic vulvovaginitis has always been one of the highest rates of outpatient visits, bar none. I remember when I first joined the workforce in the early 1990s, this disease was highly seasonal, with a peak from April to August each year. It was generally thought to be related to the rainy season, when women’s underwear was not ironed in time. At present, the seasonality is almost invisible, and such patients are encountered every working day. It is possible that the standard of living has improved greatly in the past 20 years, with excessive intake of sweet and fatty foods (which can lead to high glycogen content in the vaginal epithelium, resulting in a lower vaginal pH value conducive to the reproduction of mold); and the proliferation of unscientific private health products, excessive hygiene douching and abuse of antibiotics can disrupt the ecological balance of vaginal microorganisms, resulting in fungal reproduction.
Because Candida albicans is a conditional pathogen, 10%-20% of non-pregnant women and 30% of pregnant women have this fungus in their vagina, but the amount of fungus is small and does not cause symptoms. It is only when the immunity of the whole body and vagina decreases, especially the local cellular immunity, that Candida albicans proliferates and causes the symptoms of vaginitis.
And Candida is not resistant to heat and can die after heating to 60°C for 1 hour. That’s why it is helpful to have your underwear scalded.
It is not difficult to diagnose this disease, as soon as vulvar itching plus leucorrhoea bean curd occurs, often patients themselves will diagnose and ask for prescription of medication.
Classical clinical diagnosis
1. strange itching of the vulva with white thick bean curd-like leucorrhoea.
2. redness and swelling of the vaginal mucosa, with severe formation of shallow ulcers
3. Candida albicans is found in vaginal secretions. Take a small amount of vaginal secretion on 10% KOH or saline slide and mix it well. If the mycelium is found under the microscope, the diagnosis can be confirmed. The general positive detection rate is 70% to 80%. If there are symptoms and repeated microscopic examination is negative, the culture method can be used to culture to confirm the diagnosis.
It is recommended to check the distribution of vaginal microorganisms to understand the dominant flora in the vagina so that it can be supplemented and corrected.
Classical treatment
For simple vulvovaginal candidiasis topical medication is the main choice, usually the symptoms are reduced or disappear after 2-3 days of administration. Clotrimazole vaginal suppositories, used every 3rd day for 2 times.
Regarding the treatment of complicated vulvovaginal candidiasis, the drugs chosen are basically the same as those for simple vulvovaginal candidiasis, and the duration of treatment should be extended appropriately, regardless of local or systemic medication.
The principles of treatment for vulvovaginal candidiasis during pregnancy are: the primary consideration in treatment must be whether the drug is damaging to the fetus; treatment is based on local medication, not systemic medication; and limited to pregnant women with symptoms and signs.
It is important to emphasize that when symptoms are relieved, especially in cases of vaginal dysbiosis, timely supplementation with live vaginal lactobacilli can prevent and reduce recurrence. Because the treatment process is a “battle between good and evil”, in addition to fighting the evil, it is necessary to support the good.
From the above, prevention is especially important
1. Exercise, eat a balanced diet, and do not eat foods with high sugar content.
2. Develop good hygiene habits. Dress reasonably.
3. Avoid sitting toilets when using public toilets; promote showering. Do not be overly hygienic.
4. Do not abuse antibiotics. Do not apply the so-called private health care products without permission.
5. Actively treat diabetes.
6. If recurrent Candida vaginitis occurs in women on medication, stop using the pill and use other methods instead.