Vulvovaginitis

The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nail fungus), and yeast infections, such as those caused by Candida albicans. Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult to control. Women who are at increased risk for vulvovaginal yeast infections are those who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. 

Table 15-1, and die vulvovaginal antifungal agents are listed in Table 15-2. 

Administration of miconazole for a vulvovaginal fungal infection may cause irritation, sensitization, or vulvo-vaginal burning. Skin irritation may result in redness, itching, burning, or skin fissures. Other adverse reactions with miconazole include cramping, nausea, and headache Adverse reactions associated with topical use are usually not severe. 

Vulvovaginal candidiasis. Typical symptoms include vaginal itching and discharge. Clinical characteristics include ... 

Metronidazole (Flagyl) Vulvovaginal Candidiasis 250 mg three times daily for 7 days First-line agent in pregnancy avoid during lactation... 

O Common symptoms of menopause include hot flashes, night sweats, vulvovaginal atrophy, and vaginal dryness. Women less commonly may experience mood swings, depression, insomnia, arthralgia, myalgia, and urinary frequency. 

Hormone-replacement therapy remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy and should be considered for women experiencing these symptoms. 

Oral or transdermal estrogen products should be prescribed at the lowest effective dose for the relief of vasomotor symptoms. Topical products in the form of creams, tablets, or rings should be prescribed for women exclusively experiencing vulvovaginal atrophy. 

Hormone-replacement therapy remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy and should be considered for women experiencing these symptoms. The goals of treatment are to alleviate or reduce menopausal symptoms and to improve the patient s quality of life while minimizing adverse effects of therapy. The appropriate route of administration should be chosen based on individual patient symptoms and should be continued at the lowest dose for the shortest duration consistent with treatment goals for each patient. 

Although rare, dyspareunia may occur with vulvovaginal... 

Explain the underlying pathophysiology of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections. 

Recognize when long-term suppressive therapy is indicated for a patient with vulvovaginal candidiasis. 

O The predominant pathogen associated with vulvovaginal candidiasis is Candida albicans, although a small percentage of cases are caused by Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis. 

A variety of factors may increase the risk of developing symptomatic vulvovaginal candidiasis, including antibiotic use, diabetes, and immunosuppression. No risk factors are consistently associated with all cases of vulvovaginal candidiasis. 

Asymptomatic vaginal colonization of Candida albicans is not diagnostic of vulvovaginal candidiasis since 10% to 20% of women are asymptomatic carriers of Candida species. Asymptomatic vaginal colonization does not require treatment. 

Selection of antifungal agents to treat uncomplicated vulvovaginal candidiasis is influenced by patient preference,... 

Recurrent vulvovaginal candidiasis, defined as four or more infections per year, requires long-term suppressive therapy for 6 months. 

Vulvovaginal candidiasis (WC), whether symptomatic or asymptomatic, refers to infections in women whose vaginal cultures are positive for Candida species. 

Patients with vulvovaginal candidiasis may present with vulvar and/or vaginal symptoms. Symptoms often develop the week before menses and resolve with the onset of menses. Symptoms include ... 

TABLE 80-1. Possible Risk Factors Associated with Vulvovaginal Candidiasis (VVQ... 

Transfer of organism from rectum to vagina irritation of the vulvovaginal area during sexual intercourse may enhance invasion of organisms... 

Provide patient education pertaining to vulvovaginal candidiasis and antifungal therapy. 

McCaig LF, McNeil MM. Trends in prescribing for vulvovaginal candidiasis in the United States. Pharmacoepidemiol Drug Saf 2005 14 113-120. 

Richter SS, Galask RP, Messer SA, et al. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol 2005 43 2155-2162. 

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