A 28 -year old mother of two, consulted for persistent itching and burning sensation " makati at mahapdi " at the genital area of one week duration with associated thick
whitish vaginal discharge. Patient also complains of pain during urination and sexual intercourse.
On physical examination, there is edema and erythema of the vestibule, the labia majora and the labia minora. Some of the rash extended to the inner thighs and perineum. A white, thick, curd like, non foul-smelling vaginal discharge is also present .The medical history and thorough physical examination convinced me that the patient is suffering from. Vaginitis, most probably Candida Vulvovaginitis . Patient
was prescribed a single oral dose of Fluconazole 150mg tablet and to use Povidone-Iodine Feminine wash 2-3x a day until symptoms subsides.
Patient was also advised to wear loose-fitting clothes and use cotton underwear and if possible refrain from wearing underwear during bedtime to avoid the warm and moist climate which is conducive to the growth of Candida. Clinic follow-up after one week was also advised.
Infection of the vagina or vaginitis is considered the most common gynecological condition seen in the clinic and it is usually diagnosed based on the presence vaginal discomfort , abnormal discharge or both. To maintain a normal healthy environment in the area, a daily vaginal discharge flows that is normally clear and odorless. Variance in the color , smell, amount, consistency of the discharge and additional burning or itching sensation could mean an imbalance of healthy bacteria in the vagina thus causing vaginitis.
Bacterial vaginosis accounts for 40-45% while vaginal vulvovaginitis is second with 20-25% and lastly trichomoniasis at 15-20% for all cases of symptomatic vaginitis. A lot of cases are also mixed infections.
In vulvovaginal candidiasis, the causative agent belongs to the genus Candida, which is found in most humans and many animals. Conditions can be acute , chronic, and recurrent and may prove to be a challenge to some practitioners. There are some factors that predisposes to the growth of Candida and pregnancy is the most common condition. High doses of estrogens in some contraceptives also increase vaginal colonization by Candida. Use of antibiotics, more so the prolonged use, and also decreased or altered immune response and diabetes mellitus predisposes one to Candida vulvovaginitis.
The prominent symptom in acute vulvovaginitis is pruritus and burning sensation in the vulvar area and is aggravated during urination and after sexual intercourse.
Management and treatment involves the use of anti-fungals, both vaginal suppositories and oral tablets. Feminine wash are also prescribed to maintain the ideal vaginal ph.
Images from A.D.A.M., Google Images.
Disclaimer:
Articles on this blog should be taken for informational purposes only and is not intended to replace actual medical advice and consultation with a physician and other health practitioners.
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