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Patient Story

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An 18-year-old woman presents with severe vaginal and vulvar itching and a thick white discharge. Figure 77-1 shows the appearance of her vulva with redness and excoriations. Note the satellite lesions near the borders of the inflamed areas. Her pelvic examination demonstrated a thick adherent discharge on the vaginal wall and cervix (Figure 77-2) that is consistent with an active candida infection. Treatment with a prescription anti-candida drug was successful.

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FIGURE 77-1

Candida vulvovaginitis in an 18-year-old who complained of severe vaginal and vulvar itching. She had erythema and excoriations of the vulva. Note the satellite lesions near the borders of the inflamed areas. (Used with permission from E.J. Mayeaux, Jr., MD.)

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FIGURE 77-2

Candida vaginitis. Note the thick white adherent “cottage-cheese-like” discharge. (Used with permission from E.J. Mayeaux, Jr., MD.)

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Introduction

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Vulvovaginal candidiasis (VVC) is a common fungal infection in women of childbearing age. Pruritus is accompanied by a thick, odorless, white vaginal discharge. VVC is not a sexually transmitted disease. On the basis of clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated.1 Uncomplicated VVC is characterized by sporadic or infrequent symptoms, mild-to-moderate symptoms, and the patient is nonimmunocompromised. Complicated VVC is characterized by recurrent (four or more episodes in 1 year) or severe VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression.1

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Synonyms

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Yeast vaginitis, yeast infection, candidiasis, moniliasis.

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Epidemiology

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  • Candida (Figure 77-3) is usually not isolated in prepubertal girls except when predisposing factors, such as a recent course of antibiotics, diabetes, or the wearing of diapers are present. 2

  • VVC accounts for approximately 1/3 of vaginitis cases.1

  • Candida species are part of the lower genital tract flora in 20 to 50 percent of healthy asymptomatic women.3

  • Seventy-five percent of all women in the US will experience at least one episode of VVC. Of these, 40 to 45 percent will have two or more episodes within their lifetime.4 Approximately 10 to 20 percent of women will have complicated VVC that necessitates diagnostic and therapeutic considerations.

  • It is a frequent iatrogenic complication of antibiotic treatment, secondary to altered vaginal flora.

  • Approximately half of all women experience multiple episodes, and up to 5 percent experience recurrent disease.1

  • Recurrent vulvovaginal candidiasis (RVVC) is defined as four or more episodes of symptomatic VVC in 1 year. It affects a small percentage of women (<5%).5 Recurrent yeast vaginitis is usually caused by relapse, and less often by reinfection. Recurrent infection may be caused by Candida recolonization of the vagina from the rectum.6

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