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Vulvovaginal candidiasis, known as vaginal yeast infections,
affects the lower genital tract of women. Recently, advances
in molecular epidemiology, host mucosal immunology, and antifungal
treatment have brought up investigations into this common infection.
Women spent over half a billion dollars on medications to
treat vulvovaginal candidiasis in 2002. Half of this amount
was spent on over-the-counter preparations. However, many
women wrongly diagnose the condition and may actually suffer
from bacterial vaginosis.
It is hard to find data on the epidemiology of vulvovaginal
candidiasis, likely because vaginal colonization with Candida,
which is a prerequisite for the condition, occurs in at least
40 percent of adult women.
According to experts, at least half of women will experience
vulvovaginal candidiasis by their mid-20s, and up to 25 percent
of these women will suffer from four or more episodes a year.
Women with poorly controlled diabetes, systemic immunosuppression
or immunodeficiency, and who use antibiotics may be predisposed
to vulvovaginal candidiasis, however the pathogenesis of recurring
vulvovaginal candidiasis among women with no known risk factors
is under investigation.
Recurrent disease likely involves some breakdown of the normal
mucosal immune processes that allow for mucosal "tolerance"
to the organism. Behavioral risk factors for recurrent vulvovaginal
candidiasis are unclear, however investigators have suggested
that receptive oral sex and increasing frequency of intercourse
may play a role.
The effectiveness of suppressive treatment for women with
recurrent infections has recently been validated. Taking weekly
medication after an initial regimen of topical imidazole or
oral fluconazole works well. However, it can be difficult
to determine when to stop such a regimen, as once the medication
is stopped the episodes may start up again.
Investigators note that many symptoms attributed to vulvovaginal
candidiasis are actually caused by bacterial vaginosis, the
most common cause of vaginitis among women. Bacterial vaginosis
is often diagnosed with vulvovaginal candidiasis. Genital
herpes and genital dermatitis, such as lichen planus, may
also be misdiagnosed as recurrent vulvovaginal candidiasis.
There is debate over the effectiveness of vaginal fungal
cultures, however most experts agree that they can enhance
the sensitivity of diagnosis of vulvovaginal candidiasis in
women.
BMJ
May 10, 2003;326:993-994 (Full Text Article)
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