Document Detail

Guideline vulvovaginal candidosis (2010) of the german society for gynecology and obstetrics, the working group for infections and infectimmunology in gynecology and obstetrics, the german society of dermatology, the board of german dermatologists and the german speaking mycological society.
MedLine Citation:
PMID:  22519657     Owner:  NLM     Status:  In-Data-Review    
Candida (C.) species colonize the estrogenized vagina in at least 20% of all women. This statistic rises to 30% in late pregnancy and in immunosuppressed patients. The most often occurring species is Candida albicans. Host factors, especially local defense deficiencies, gene polymorphisms, allergic factors, serum glucose levels, antibiotics, psychosocial stress and estrogens influence the risk for a Candida vulvovaginitis. In less than 10% of all cases, non-albicans species, especially C. glabrata, but in rare cases also Saccharomyces cerevisiae, cause a vulvovaginitis, often with fewer clinical signs and symptoms. Typical symptoms include premenstrual itching, burning, redness and non-odorous discharge. Although pruritus and inflammation of the vaginal introitus are typical symptoms, only less than 50% of women with genital pruritus suffer from a Candida vulvovaginitis. Diagnostic tools are anamnesis, evaluation of clinical signs, the microscopic investigation of the vaginal fluid by phase contrast (400 x), vaginal pH-value and, in clinically and microscopically uncertain or in recurrent cases, yeast culture with species determination. The success rate for treatment of acute vaginal candidosis is approximately 80%. Vaginal preparations containing polyenes, imidazoles and ciclopiroxolamine or oral triazoles, which are not allowed during pregnancy, are all equally effective. C. glabrata is resistant to the usual dosages of all local antimycotics. Therefore, vaginal boric acid suppositories or vaginal flucytosine are recommended, but not allowed or available in all countries. Therefore, high doses of 800 mg fluconazole/day for 2-3 weeks are recommended in Germany. Due to increasing resistence, oral posaconazole 2 × 400 mg/day plus local ciclopiroxolamine or nystatin for 15 days was discussed. C. krusei is resistant to triazoles. Side effects, toxicity, embryotoxicity and allergy are not clinically important. A vaginal clotrimazole treatment in the first trimester of pregnancy has shown to reduce the rate of preterm births in two studies. Resistance of C. albicans does not play a clinically important role in vulvovaginal candidosis. Although it is not necessary to treat vaginal candida colonization in healthy women, it is recommended in the third trimester of pregnancy in Germany, because the rate of oral thrush and diaper dermatitis in mature healthy newborns, induced by the colonization during vaginal delivery, is significantly reduced through prophylaxis. Chronic recurrent vulvovaginal candidosis requires a "chronic recurrent" suppression therapy, until immunological treatment becomes available. Weekly to monthly oral fluconazole regimes suppress relapses well, but cessation of therapy after 6 or 12 months leads to relapses in 50% of cases. Decreasing-dose maintenance regime of 200 mg fluconazole from an initial 3 times a week to once monthly (Donders 2008) leads to more acceptable results. Future studies should include candida autovaccination, antibodies against candida virulence factors and other immunological trials. Probiotics should also be considered in further studies. Over the counter (OTC) treatment must be reduced.
W Mendling; J Brasch
Related Documents :
2912077 - Abnormal fetal heart rate patterns and placental inflammation.
12492807 - Fetal heart rate decelerations during ect-induced seizures: is it important?
3066887 - Methodology and clinical value of transcutaneous blood gas measurements in the fetus.
19436477 - Ultrasonographic fetal well-being assessment, neonatal and postpartum findings of clone...
8807757 - Transcervical chorionic villus sampling beyond 12 weeks of gestation.
17003547 - A case of monochorionic twin pregnancy complicated with intrauterine single fetal death...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Mycoses     Volume:  55 Suppl 3     ISSN:  1439-0507     ISO Abbreviation:  Mycoses     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-04-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8805008     Medline TA:  Mycoses     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1-13     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Verlag GmbH.
Prof. Dr. med. Werner Mendling, Vivantes - Klinikum im Friedrichshain and Am Urban, Clinics for Obstetrics and Gynecology (2011 retired), 10249 Berlin, Landsberger Allee 49 Prof. Dr. med. Jochen Brasch, University Hospitals of Schleswig - Holstein, Campus Kiel, Department of Dermatology, Venerology and Allergology, Schittenhelmstrasse 7, 24105 Kiel, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The "Swiss Statement": Who knows about it? How do they know? What are its effects on people living w...
Next Document:  Rapid clinical induction of bupropion hydroxylation by metamizole in healthy Chinese men.