Vaginal candidiasis – the mycosis of a mucous membrane of a vagina arising at its colonization by strains of drozhzhepodobny mushrooms of Candida. In a sharp stage reddening, hypostasis and an itch of a vulva are noted; morbidity, burning and an itch in a vagina; plentiful, a curdled type of allocation from a genital tract; in chronic - dryness and an atrophy of a mucous membrane, an ekskoriation, the expressed likhenization. The diagnosis of vaginal candidiasis is established according to a clinical picture, a microscopic and cultural research. At vaginal candidiasis system and local antimikotichesky means, polyvitamins, immunostimulators are appointed.
Vaginal candidiasis, or the milkwoman – a kind of a vaginal fungal infection which activator are microscopic drozhzhepodobny fungi of a sort Candida (Candida albicans). Candida infection has the big importance in obstetrics and gynecology in connection with wide circulation and increase in incidence in recent years. Among vaginal infections candidiasis is on the second place after a bacterial vaginosis. Vaginal candidiasis usually affects women of childbearing age (pregnant women - 2-3 times more often), prior to the beginning of menarche and in a postmenopause meets seldom. The barmy infection of a vagina can exist in the form of an asymptomatic kandidonositelstvo and true vaginal candidiasis - sharp (lasting up to 2 months) and chronic recuring (proceeding more than 2 months).
Reasons of vaginal candidiasis
Vaginal candidiasis is caused by the opportunistic drozhzhepodobny mushrooms of the sort Candida living on skin and mucous membranes of a mouth, a GIT, genitalia and vaginas of healthy women. Change of growth phases (a pseudo-mycelium and a blastospor) gives to fungi the chance to survive in the wide temperature and acid range. Candide's death causes boiling within 10-30 min., processing by formalin, a copper vitriol, carbolic and boric acid. Presence at mushrooms of a mannoprotein cover and enzymes (proteinases and catalases) allows to resist to immune system of a macroorganism easier.
As the dominating causative agents of vaginal candidiasis (in 75-80% of cases) the strains of C. albicans having high pathogenic potential act. The vaginal candidiasis caused by other types (C.glabrata, S. of tropicalis, C. krusei, C.parapsilosis) is more typical for certain ethnic groups (representatives of the African race) and geographical areas (the coast of the Mediterranean Sea, the Middle East) that it is connected with specifics of a microbiocenosis mucous and skin, food and living conditions.
As a rule, vaginal candidiasis is the endogenous infection developing in the conditions of an asymptomatic kandidonositelstvo, usually vaginal, is more rare - on a mucous oral cavity, intestines and skin. For example, the recidivous form of vaginal candidiasis is caused by Candide's persistention in intestines and periodic receipt of the activator in a vagina and its colonization. At vaginal candidiasis Candide's pseudo-mycelium usually gets only into vagina epithelium blankets, mentions deeper fabrics with the subsequent hematogenic distribution and defeat of various bodies less often.
Emergence of vaginal candidiasis is promoted by the insufficiency of protective system of an organism owner which is shown decrease in local immunity of a vagina. The local immunodeficiency concerning Candide's anti-genes (decrease of the activity of macrophages and lymphocytes) does not allow to block receptors and enzymes of mushrooms.
Vaginal candidiasis usually is not followed by noticeable reduction of level of lactobacilli and change of normal microflora of a vagina; but at formation of polymicrobic associations it can be combined with a bacterial vaginosis.
Violation of balance of sex hormones at pregnancy, reception of hormonal contraceptives, endocrine pathology disposes to development of vaginal candidiasis. Influence of fluctuation of estrogen and progesterone on mucous vaginas is shown by increase in concentration of a glycogen in epiteliotsita, stimulation of their sensitivity to kandida and more effective adhesion of mushrooms. Vaginal candidiasis accompanies various states connected with immunosupression much more often (HIV infection, diabetes, tuberculosis, hypovitaminosis, excessive application of antibiotics, corticosteroids, tsitostatik, radiation therapy, etc.). Vaginal candidiasis can be associated with atopic manifestations (allergic rhinitis, food allergy).
Food errors, application of hygienic means (laying, tampons), wearing close clothes are not considered as significant factors of development of vaginal candidiasis. There is a probability of transfer of a kandida-infection to the newborn when passing in patrimonial ways of sick mother; sexual transmission is possible; the risk of infection is higher at frequent oral and genital contacts.
Symptoms of vaginal candidiasis
At a kandidonositelstvo clinical manifestations are not noted, patients of complaints, as a rule, do not show. At sharp vaginal candidiasis there are plentiful dense white-gray allocations from a vagina, a curdled view with a sour smell. The mucous membrane affected with vaginal candidiasis is edematous, hyperemic and inclined to bleeding. On it the roundish and oval centers of a curdled raid and films which are sharply delimited or merging with each other, by the size from dot to 5-7 mm in the diameter are noted. In a sharp phase raids are densely attached to mucous and are hardly cleaned off with an exposure of a brilliant erozirovanny surface with scalloped edge; later easily act, being allocated from a genital tract. The itch and burning in a vulva amplifying during periods after physical activity, water procedures is typical for vaginal candidiasis. Patients are also disturbed by sharp painful feelings at sexual intercourse.
At chronic vaginal candidiasis lack of characteristic allocations is possible, small hyperaemia of a mucous membrane, poor films and dry erosion, the expressed likhenization and ekskoriation are noted. The mucous membrane becomes flabby, atrofichny, the entrance to a vagina is narrowed, hemorrhagic rashes can develop. The chronic form has a long long-term current.
Vaginal candidiasis usually extends to external and internal genitals, an urethra with development of a kandidozny vulvovaginit, tservitsit and uretrit. Vaginal candidiasis can be the cause of termination of pregnancy (a spontaneous abortion, premature birth), development of an endometritis in the postnatal period, infertility.
Diagnosis of vaginal candidiasis
The diagnosis of vaginal candidiasis existence of clinical symptoms of an infection and allocation of culture of mushrooms with mucous confirm vaginas during the microbiological research. Survey of a neck of a uterus and vagina by means of mirrors reveals hyperaemia, puffiness mucous, gray-white curdled raids in its folds. When coloring solution of Lugol shows melkotochechny impregnations and the expressed vascular drawing. Allocations at vaginal candidiasis are found approximately in 76% of cases, an itch – in 32%.
At a microscopic research of dab the rounded oval, budding with places cages are defined. At a bakposeva on Saburo's circle convex brilliant white colonies of rounded shape are found. Specific identification of mushrooms and definition of their sensitivity to medicines, complex PTsR-diagnostics and IFA on STD activators is carried out. If necessary inspection is supplemented with a bacteriological research of urine and dab of an urethra on microflora, the analysis a calla on dysbacteriosis, definition of sugar of blood, ultrasonography of bodies of a small pelvis, abdominal cavity and bladder.
Treatment and prevention of vaginal candidiasis
Complex treatment of vaginal candidiasis includes influence on the activator - Candida mushrooms, elimination of provocative factors, therapy of the accompanying pathology.
At vaginal candidiasis various groups of antifungal means are systemically and locally applied: half-yen antibiotics (nystatin, ), antimycotics of an imidazolny and triazolny row (, , , ). Good results in treatment of vaginal candidiasis are shown , possessing a wide range of fungistatic action, not giving side effect on synthesis of steroids also by metabolism. Efficiency of single oral administration of a high dose gives advantage before other antimycotics.
At an easy current local medicines (, ) in the form of cream, vaginal candles and tablets are shown. At a chronic infection reception of system antifungal medicines is repeated certain courses. Purpose of low-toxic forms of antimycotics to pregnant women is preferable (the natamitsina, nifuratet intravaginalno) and at children's age (a nifuratela in applications and intravaginalno, a flukonazola orally).
Therapy of vaginal candidiasis can be added with local application disinfecting and resolvents - solutions drills in glycerin, permanganate of potassium and nitrate of silver in the form of trays and syringings. At vaginal candidiasis of polymicrobic genesis combinations of antimycotics with metronidazole are appointed. Immunity correction is carried out by immunoexcitants, reception of polyvitamins is shown. The Izlechennost from vaginal candidiasis is defined by disappearance of clinical signs and negative result of a microbiological research.
Prevention of vaginal candidiasis consists in elimination of conditions for its development: reception restriction COOK, antibiotics, tsitostatik; medicamentous correction of an immunodeficiency, endokrinopatiya and other accompanying pathology, preventive inspection of women by the gynecologist.