It’s a common disease, and it seems I can’t justify it without doing a little bit of science.
First of all, the standard medical diagnosis has been revised to “Vulvovaginal Candidiasis”, or VVC for short, which used to be called Candida vaginitis, but since mycosis vaginalis is the most commonly used, I still use the previous name. I still use the previous name in the title.
It is common because about 75% of women have at least one episode in their lifetime, while 40-50% have more than 2 episodes, and a small percentage of 5-8% may have more than 4 episodes a year, and the last part can again be diagnosed as recurrent vulvovaginal pseudomycosis, or RVVC, or some patients are more symptomatic, and the latter two together are called complicated VVC.
The main manifestations of VVC are increased vaginal discharge, vaginal itching, frequent urination, painful urination and painful intercourse, and typical leukorrhea that resembles tofu-like leukorrhea. The vulva and vagina may appear red and edematous.
The diagnosis of this disease is usually not difficult. A leuko examination at the hospital can usually clarify the diagnosis, and sometimes the leuko cannot detect Candida at once, and a culture can also help.
Under normal circumstances, there is lactobacillus in human vagina to maintain the weak acidic environment in the vagina, pseudomonal yeast is a common parasitic bacteria in women’s vagina; when the body resistance decreases, especially the local resistance, or when the virulence of pseudomonal yeast increases, the body resistance is weaker than the invasion, which eventually leads to the proliferation of pseudomonal yeast, through the destruction of the body’s vaginal epithelial cells, forming VVC. VVC. pseudomonal yeast is not a bacterium, it is a type of fungus.
VVC alone is not difficult to treat, and can be treated with vaginal antifungal suppositories (the specific duration of use depends on the drug used), without the need for oral antifungal drugs. Treatment of VVC alone can be done with one of the following treatment options.
1. Clotrimazole
Clotrimazole suppositories or clotrimazole tablets 500 mg in a single dose.
Clotrimazole suppository 100 mg once a night for 7 days.
2.Miconazole
Miconazole soft capsule 1200 mg, single dose.
Miconazole suppository or Miconazole soft capsule 400 mg, once a night for 3 days.
Miconazole suppository 200 mg once a night for 7 days.
3.Mycetin
100,000 units of mycoplasma effervescent tablets, 1 time every night for 14 days.
Mycoplasma tablets 500,000 units, once a night for 14 days.
4.Fluconazole
Fluconazole 150mg, once a day, for 1 time.
Some of the above drugs are over-the-counter and can be bought in pharmacies, but in the first occurrence, it is recommended to go to the hospital for diagnosis instead of using drugs indiscriminately by yourself. Common antibacterial drugs are ineffective against fungi and may aggravate the fungal infection. There are other non-fungal causes of vaginal leucorrhea diagnostic itching. In the past, VVC treatment strategies also included vaginal douching, but this measure is no longer recommended, as evidence from evidence-based medicine has shown that vaginal douching increases the incidence of pelvic inflammatory disease and ectopic pregnancy. Avoid sexual intercourse during treatment. It is only necessary to review the leukorrhea one week after treatment or at the next menstrual period.
About 84% of women experience recurrence after their first VVC and the reasons for recurrence are varied. Pregnancy, oral contraceptive use, antimicrobial use, diabetes, vaginal douching, immunosuppressants, HIV infection, all of these factors contribute to VVC recurrence, and some will have a somatic susceptibility, related to genetics. Knowing these triggers can make it interesting to avoid them, such as avoiding the use of “anti-inflammatory drugs” and avoiding vaginal douching (in fact, vaginal douching is not recommended at any time, so I will write more about this later).
The treatment of recurrent VVC starts with an investigation of the presence of the above mentioned causes of VVC. Treatment strategies include intensive therapy and consolidation therapy. Intensive treatment regimens may include one of the following options.
1. Clotrimazole
Clotrimazole suppositories or tablets 500 mg, applied on days 1, 4 and 7.
Clotrimazole suppository 100 mg, applied once a night for 7-14 days.
2.Miconazole
Miconazole suppository or soft capsule 400 mg, 1 time every night for 6 days.
Miconazole suppository 1200 mg, applied on day 1, day 4 and day 7.
3.Fluconazole
Fluconazole 150 mg, administered by mouth, applied on day 1, day 4 and day 7.
After the review to know no fungal presence, the next step is to consolidate the treatment. There are no more mature protocols in China or abroad. For those who have regular attacks once a month, preventive medication can be administered once before each attack for 6 months. For those who have irregular episodes, medication can be given once a week for 6 months.
Sexual partners also do not need to be treated. About 15% of men have glansitis after contact with female patients, and symptomatic men should be examined and treated for pseudofilamentous yeast to prevent repeat infection in women.
VVC attacks during pregnancy are also a common problem. Medications can be used during pregnancy, but oral medications cannot be used during pregnancy. Of the vaginal suppositories, clotrimazole is a class B drug and is safe to use, miconazole and fluconazole are class C drugs.