They include Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei. Other Candida species may also be causal. 1,9-11 Its high incidence is due to the fact that it is fully viable under a wide range of temperatures and pH levels. 2,8 It is a normal commensal opportunistic resident of the genital and gastrointestinal tracts, being found in 20% to 25% of females who are asymptomatic. 7 The prime offender is Candida albicans, the causal organism in 80% of cases. While there are other causes of vaginitis (e.g., Trichomonas, contact dermatitis, irritant dermatitis), the most common cause is fungal. If they cleanse from the bottom forward, they may carry fecal candida to the vagina, thus increasing the risk of VVC. 6 Women must be taught to cleanse correctly following bowel movements. 5 Patients with diabetes are also more prone to experience VVC. Impaired cell-mediated immunity (e.g., HIV/AIDS, high-dose corticosteroids, other immunosuppressants) hinders the patient in combating infection, thus increasing risk.
Estrogens, whether administered for postmenopausal replacement or as oral contraceptives, enhance vaginal cell glycogen production, facilitating adherence by candidal organisms. Antibiotics alter the normal vaginal microenvironment, giving candidal organisms an advantage. 2 Medications can be causal or contributory. 2,4 Age is predictive, in that the incidence rises rapidly after menarche, but drops precipitously after menopause. 2 Three-fourths of women will experience one or more incidents of VVC in their lifetime, and an estimated 40% to 45% will have two or more episodes. Vaginitis is the presenting complaint in over 10 million physician visits annually. Prior to use, the patient must understand proper application, contraindications, and whether use of the product is appropriate at all. However, vaginal antifungals are not the simple products they seem to be. Instead, they attempt self-treatment with nonprescription products.
1 For a variety of reasons, many patients do not wish to see a prescriber. Vaginal fungal infections, also known as vulvovaginal candidiasis (VVC) or yeast infections, are common and often frequently recurring female genital problems.
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