Yeast Infection
Yeast Infection: What is it
Candidiasis is an overgrowth of yeast in the vagina, vulva, groin, or other moist areas of the body. 75% of people with vaginas will have a yeast infection in their lifetime, also known as vulvovaginal candidiasis (VVC).
Yeast Infection: VVC - Complicated
Complicated VVC is classified as four or more yeast infections per year, coupled with symptoms more severe than an uncomplicated yeast infection. It is seen more frequently in immunocompromised people and always requires more intense treatment.
Yeast Infection: Diagnosing
Diagnosing can include evaluating signs and symptoms, a physical exam, microscopic evaluation, microbial culture, or serology for antigens.
Yeast Infection: Differential Diagnoses
Differential diagnoses include leukorrhea, BV, chlamydia, gonorrhea, and trichomonas.
Yeast Infection: Use of Abx
If symptoms do not improve within the week referral to a physician for antibiotics is recommended. Vaginal tablets and creams, topical treatments, and oral medications may be used, all would be antifungals agents. These work by interfering with the formation of fungal cell membranes. The most commonly prescribed antibiotic treatments include Miconazole, as previously mentioned (1% cream 5 g PV for 1 week), Clotrimazole (1% cream 5 g PV for 1 week), and Terconazole (0.4% 5 g PV for 1 week).
Yeast Infection: Diagnosing - Microscopy
Microscopy, or vaginal wet mouth microscopy, involves swabbing the affected area, then placing a specimen on a microscope slide with 1 ggt of KOH and saline. The KOH will dissolve skin cells, but not candida cells, so if hyphae and budding yeast cells are visualized, a positive diagnosis is made. Hyphae are a part of the fungus and are a way to measure the growth and presence of bacteria; hyphae may or may not be present with recurrent or severe VVC s some forms of candida do not form hyphae. Hyphae and buds will appear as long, translucent strands on a slide of saline and 10% KOH solution. If they are not visualized it is recommended that culture is performed to look for other non-albicans yeast strains.
Recurrent VVC: Etiology
Recurrent VVC is most likely caused by different species each time an infection occurs.
Yeast Infection: Referrals
Referrals would be indicated if the infection was recurrent or complicated, or if treatment with antibiotics as necessary.
Yeast Infection: Risk Factors
Risk factors include nonbreathable clothing, humid/warm climates, the hormonal changes of pregnancy, use of oral contraceptives, antibiotic treatment, being immunocompromised, and using corticosteroids. Pregnancy increases one's risk of a risk infection due to changes in estrogen and progesterone. Yeast infections are not contagious, but some species that cause infection can be passed between sexual partners. Finally, treatment of BV with antibiotics increases the risk of a yeast infection as it creates a hospitable environment for the overgrowth of certain bacteria.
Yeast Infection: Signs and Symptoms - Severe
Severe candidiasis presents with severe erythema, skin fissures, edema, and excoriations.
Yeast Infection: Signs and Symptoms
Signs and symptoms include burning, itching, irritation, dyspareunia, and dysuria. Discharge that is malodorous, thick, white, and curd-like is also common, but can also present as thin and watery; it also sticks to the vaginal walls. The vulva may appear edematous and erythematous with small (1-2mm) satellite lesions extending from the affected area.
Yeast Infection: Diagnosing - Agar Plate
The culture method, or microbial culture, looks for the growth of yeast bacteria on an agar plate. It involves wiping a sterile swab on the affected area to collect a sample, streaking it onto the agar plate, incubating at 98.6F for a few days to allow the yeast to develop. The characteristics of the results, such as the morphology and color, help diagnose the organism causing the infection.
Yeast Infection: 1st Line of MW Management
The first line of midwifery management would include probiotics (especially those that contain lactobacillus), garlic suppositories, reducing the refined sugars and yeast containing products (dietary), working to decrease vaginal moisture (wearing cotton undies can help with this), and recommendations such as no douching or feminine products. This can be down for a week, with or without the use of Monistat (Miconazole) 1% cream 5 g PV for 1 week.
Yeast Infection: Etiology
The most common cause of yeast infections is the bacteria candida Albicans, but it can be caused by other species of bacteria (which will make it harder to treat) and presents as an overgrowth of normal flora.
Yeast Infection: Implications
There are no serious implications of yeast infections, other than general discomfort. Systemic candidiasis is very rare in newborns, but thrush is more common
Yeast Infection: Treatment of recurrent candida-Albicans strains
Treatment of recurrent candida-Albicans strains involves a longer course of antibiotics combined with topic treatment.
Yeast Infection: Tx of Recurrent Candidiasis - Non-medical
Treatment of recurrent candidiasis first includes ruling out conditions such as HIV or DM, and testing for non-albicans candida strains. Additionally, a person should examine their lifestyles, such as the use of oral contraceptives, sexual practices, antibiotic uses, tight clothing, and vulva care. Spermicides should also be avoided.
Yeast Infection: Treatment of recurrent non-candida Albicans
Treatment of recurrent non-candida Albicans strains includes boric acid suppository capsules (600 mg qd PV for 2 weeks) or a Nystatin suppository (100,000 u qd PV for 2 weeks). Clients must be advised that they should finish the course of antibiotics. This is followed by a maintenance regime that includes suppressive therapy, and identification of the species.
Yeast Infection: VVC - Uncomplicated
Uncomplicated VVC presents and mild to moderate symptoms, and people have sporadic infections, but much less so than compared to complicated VVC. VVC is not contagious.
Yeast Infection: VVC
VVC is an overgrowth of normal vaginal flora that causes a fungal infection presenting as irritation, discharge, and pruritis of the vulva and vagina. There are two types of VVC, complicated and uncomplicated.
