Vulvovaginal candidiasis
Vulvovaginal candidiasis (VVC) is a disease that more than 75% of all women will encounter in their lifetime. On average, fifty percent of these women will have VVC return at some point in their lives. Many risk factors are known to increase susceptibility to VVC. These are, for example, pregnancy, immunosuppression, antibiotic treatment or diabetes. Another factor for the development of VVC can be an imbalance of the vaginal microbiome, which significantly contributes to a woman's vaginal health. VVC is very common in women of reproductive age, so it is important to know the mechanism of this disease and its treatment.
The vaginal microbiome has been found to be related to the success of in vitro fertilization, reduces the risk of preterm birth and plays an important role in the prevention of urogenital infections. The normal vaginal environment consists of only a few types of bacteria. The specific environment of the vaginal mucosa is formed most often by bacteria of the genus Lactobacillus spp .. In gynecology and obstetrics, lactobacilli are mainly used to restore the physiological vaginal microflora, for the purpose of treating bacterial vaginosis and vulvovaginal candidiasis. The growth of lactobacilli is dependent on the secretion of estrogens, therefore hormonal fluctuations can cause inflammation.
There are different types of yeast that colonize the vaginal environment. The most common yeast is Candida albicans , but non-albicans species can also colonize the vaginal environment ( Candida glabrata, Candida parapsilosis ...). A polymorphic fungus Candida albicans may be a normal part of the human microflora. Under certain circumstances, for example with reduced immunity, the yeast can overgrow and cause an inflammatory disease. Candida glabrata is the second most common species of the genus Candida . Its pathogenicity is limited in healthy hosts and it is considered a relatively non-pathogenic commensal of the vagina. However, cases of vaginitis and infections of the upper genital tract have been described. Exceptionally, it can cause mucosal or systemic infections in immunocompromised patients.
The increased risk of colonization and development of VVC in pregnancy is attributed to pregnancy-related factors. They are reduced cellular immunity, increased estrogen levels and increased production of mucosal vaginal glycogen. Elevated levels of estrogen make it easier for yeast to adhere to vaginal epithelial cells. In addition, estrogen promotes the formation of hyphae and the production of enzymes. These virulence factors facilitate yeast colonization. Immunological changes in pregnancy may contribute to changes in the severity and susceptibility to infections during pregnancy. As pregnancy progresses, hormone levels change dramatically, being higher than at any other time. The interplay between hormones and the immune system must therefore be complex and multifactorial.
Symptoms of vulvovaginal candidiasis are itching, burning, redness, swelling and discharge. Recently, evidence has emerged suggesting that candidiasis in pregnancy may be associated with complications during pregnancy. At the same time, studies say that curing VVC during pregnancy has led to a reduction in the risk of premature birth. Vaginal candida infections causing chorioamnionitis (inflammation of the amniotic sac) are very rare.
Treatment of pregnant women is primarily indicated to relieve symptoms. In particular, recurrent vulvovaginal candidiasis contributes significantly to discomfort during pregnancy. There is no evidence that individual symptoms are more severe in pregnant than in non-pregnant women. For symptomatic VVC infection, most doctors treat with topical imidazole, clotrimazole, or miconazole vaginally for 7 days.
Although the evidence is not 100 percent, data suggest that candidiasis in pregnancy may be associated with an increased risk of pregnancy complications. These can be premature birth, chorioamnionitis or congenital skin candidiasis. Although most doctors do not treat asymptomatic vaginal yeast colonization, yeast screening is routine in some countries. Doctors treat symptomatic VVC during pregnancy mainly with topical imidazole for 7 days in order to minimize drug exposure.
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