| Autor: | LInhares, Iara, Haddad, Jorge Milhem, Fukazawa, Eiko, Baracat, Edmund Chada |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: | |
| DOI: | 10.5680/lhuii000053 |
| Popis: | Vulvovaginal candidiasis (VVC) is one of the most frequent infections of the female genital tract; 75% of women of reproductive age will have one episode, and 5% of these will have recurring episodes (>3 a year). Symptoms can be quite unpleasant and impact the quality of life. World incidence is difficult to estimate accurately, for notification is not mandatory. Nonetheless, population estimates range from 5% to 25%. The fungi exist as saprophytes in the genital tract, but when local defense mechanisms fail, they proliferate and symptoms appear. The mechanisms determining such a transition are still unclear. The most frequent species, Candida albicans, accounts for 85% to 95% of the cases, and other species (C. glabrata, C. krusei, C. paratropicalis, C. guilhermondi, etc.), for the remainder. Although some factors are thought to predispose to VVC (diabetes mellitus, pregnancy, high-dosage contraceptives), it is impaired local immunity which seems to underlie recurring phenomena. The most frequent symptom is itching, usually accompanied by white vaginal discharge, dysuria, and dyspareunia. Examination reveals signs of vulva inflammation often with fissures and lacerations in severe cases and a white content, in moderate or abundant quantity, adhered to the vaginal walls. Diagnosis should be confirmed by microscopy with 10% saline or KOH solution. In cases of clinical suspicion and negative microscopy, a culture should be carried out to enable identification of the fungal species and sensitivity tests applied in recurring cases. For treatment, azoles delivered systemically or vaginally or polyenes via the vaginal route produce good results in sporadic episodes. During pregnancy, only the vaginal route should be used. Recurring episodes may be treated with 3 doses of 150 mg of fluconazole at 72-hour intervals, followed by a once-a-week use of the medication for 6 months. Treatment does not eradicate the fungus completely; recurrences occur in nearly 42.5% of women six months after therapy. The non-albicans strains do not usually respond well to azoles; amphotericin B or 600 mg boric acid ovules can be used instead. In refractory cases, 17% flucytosine is recommended. There is no vaccine for vulvovaginal candidiasis yet. Chapter of the Living Handbook Urogenital Infections and Inflammations |
| Databáze: | OpenAIRE |
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