Candidiasis (thrush): causes, treatment and prevention of relapses in Tashkent

What is candidiasis and why is it not an external infection?

Fungi of the genus Candida are common inhabitants of the human body. They are present in the mouth, intestines and mucous membranes of most people and do not manifest themselves in any way while they are restrained by competing bacteria and the immune system. In the vagina, this role is played by lactobacilli: they maintain an acidic environment in which it is difficult for fungus to reproduce. When the defense weakens - for example, an antibiotic destroys lactobacilli along with the causative agent of sore throat - candida gains freedom and begins to grow rapidly. Itching, burning and characteristic cheesy discharge appear. This is not the result of “contagion”, but an imbalance.

Understanding this mechanism changes the attitude towards the disease in several practical issues at once. It becomes clear why thrush can appear in a woman who does not have sexual intercourse and in a baby in the first weeks of life. Why does it come back again and again if the background factor is not eliminated, for example, undiagnosed diabetes or the habit of douching. And why attempts to “burn out” the fungus with aggressive antiseptics have the opposite effect: along with Candida, lactobacilli, which are the only ones able to restrain it, also die. The goal of treatment is not sterility, but restoration of balance.

• Vulvovaginal candidiasis is the most common form; Most women experience at least one episode in their lives
• Candidiasis balanoposthitis in men - redness, itching, white coating on the head of the penis
• Candidal stomatitis - white plaque in the mouth; in infants, in elderly people with removable dentures, in patients using inhaled hormones for asthma
• Candidiasis of skin folds - under the breasts, in the groin, between the fingers; more often with excess weight and in hot weather
• Candidiasis of the nails and periungual ridges - in people whose hands are constantly in a damp environment
• Esophageal candidiasis is a severe form, occurs with a pronounced decrease in immunity and requires a separate examination

It is worth mentioning separately that thrush is far from being just a women’s issue, although in everyday language the word is assigned specifically to the vulvovaginal form. In men, candidal balanoposthitis is less common, but it looks recognizable: redness, itching, white plaque and small cracks. An important detail: if such an episode occurs for the first time and without an obvious reason, the doctor will definitely check the blood glucose level, because this is a classic debut of diabetes mellitus. In infants, candidal stomatitis is typical - a white coating in the mouth, which, unlike milk residues, does not wash off easily; it responds well to treatment, but nipples, bottles and pacifiers need to be treated at the same time, otherwise history will repeat itself.

What triggers an exacerbation

For most people, thrush does not appear out of nowhere: you can almost always find an event that preceded the episode. Understanding your trigger is more important than the fact of treatment itself, because it depends on it whether history will repeat itself in a month.

• Antibiotics are the most common and most recognizable trigger: they destroy lactobacilli, and the fungus takes up the vacant space, usually in the second or third week after the start of the course
• Diabetes mellitus and simply high glucose levels - sugar in tissues and mucous membranes serves as a nutrient medium
• Pregnancy - due to changes in hormonal levels and microflora composition
• Hormonal medications, including some contraceptives
• Glucocorticoids, chemotherapy, post-transplant status, HIV infection
• Douching and aggressive washing with soap from the inside are a direct blow to natural protection
• Tight synthetic underwear, panty liners without frequent changes, long stays in a wet swimsuit
• Heat and high humidity, which is especially important in the summer months

Not everything that looks like thrush is one.

This is perhaps the most practically important part of the topic. Itching and discharge are non-specific symptoms and occur in a number of very different conditions that require different treatments. Advertising has taught people to consider any discomfort as thrush, so a person buys an antifungal agent, it, as expected, does not help, and one gets the impression of “incurable chronic thrush.”

There is also the opposite error, no less frequent. Sometimes manifestations of a sexually transmitted infection are mistaken for thrush, and they are treated with suppositories from the pharmacy. The symptoms are muffled, the inflammation goes deeper, but the infection continues to exist and gradually rises higher - to the uterus and fallopian tubes. A few years later, a woman comes in about chronic pain or difficulties in getting pregnant. This is why the first episode and any atypical case should be shown to a doctor once - it’s cheaper and faster than dealing with the consequences.

• Bacterial vaginosis - discharge is gray, liquid, with a distinct fishy odor, itching is usually mild; treated with completely different drugs
• Trichomoniasis is a foamy, yellowish-green discharge that is a sexually transmitted infection.
• Aerobic vaginitis - purulent discharge, severe redness
• Atrophic changes in postmenopause - dryness, burning, discomfort with intimacy, little discharge
• Contact and allergic dermatitis - reaction to pads, intimate hygiene gels, soap, latex, washing powder
• Lichen sclerosus - persistent itching, changes in skin color and structure; requires observation by a dermatologist
• Chlamydia, gonorrhea and other infections can occur with scanty symptoms and require separate tests

It is impossible even for an experienced doctor to distinguish these conditions “by feeling” without examination and a smear. That is why, for the first episode and for any repetition after unsuccessful treatment, you do not need advice from the Internet, but a simple and inexpensive laboratory test.

Survey

1. Осмотр врача — оценка характера налёта, покраснения, отёка, состояния кожи и слизистых.
2. Микроскопия мазка — базовый метод: показывает нити псевдомицелия и почкующиеся клетки грибка, а заодно позволяет увидеть признаки бактериального вагиноза и воспаления.
3. Измерение кислотности среды — простой ориентир, помогающий отличить кандидоз от бактериального вагиноза.
4. Посев с определением вида грибка и его чувствительности — назначают при повторяющихся эпизодах и при неэффективности стандартного лечения. Это важно, потому что не все виды кандиды одинаково реагируют на обычные препараты.
5. Обследование на инфекции, передающиеся половым путём, — при соответствующей клинической картине.
6. Глюкоза крови и гликированный гемоглобин при рецидивирующем течении: нередко именно повторяющаяся молочница становится первым сигналом о нераспознанном диабете.
7. При тяжёлом и упорном течении — оценка иммунного статуса и тест на ВИЧ по решению врача.

Treatment and why candidiasis returns

An uncomplicated episode can be treated simply and quickly: antifungal drugs are used topically in the form of suppositories and creams or once orally. The choice of a specific form depends on the severity of symptoms, pregnancy, concomitant diseases and patient preferences, and is prescribed by the doctor. Symptoms usually subside within 1-3 days, but it is important to complete the course completely, even if it becomes easier.

1. Неосложнённая молочница — короткий курс местных средств или однократный приём препарата внутрь.
2. Тяжёлое течение с выраженным отёком и трещинами — более длительный курс, иногда комбинация местной и системной терапии.
3. Рецидивирующий кандидоз — четыре и более эпизода за год. Здесь применяется принципиально другая тактика: сначала полное купирование обострения, затем поддерживающая схема на несколько месяцев по расписанию. Короткие курсы «по факту зуда» в этой ситуации не работают.
4. Обязательный шаг при рецидивах — поиск и устранение фонового фактора: контроль сахара крови, пересмотр гормональной терапии, отказ от спринцеваний, замена средств интимной гигиены.
5. Беременность — только препараты, разрешённые врачом; многие системные средства в этот период неприменимы.
6. При кандидозе полости рта у пользователей ингаляционных гормонов — обязательное полоскание рта после каждой ингаляции и обработка съёмных протезов.

What has no proven benefit: douching with any solutions, including soda and herbs; “antifungal diets” with a complete rejection of sugar and yeast; garlic and kefir tampons; treatment with aggressive antiseptics. Probiotics are being studied, but are not a replacement for treatment. All of the above have one thing in common - these methods disrupt your own microflora and delay a visit to the doctor.

Should my partner be treated?

This is probably the most frequently asked question on the topic, and the answer is surprising to most people. Routine simultaneous treatment of the sexual partner for ordinary thrush is not required and does not reduce the frequency of recurrent episodes. The reason is simple: the source of the fungus is the woman’s own microflora, and not the partner.

• The partner is treated only if he has symptoms: redness, itching, burning, white coating, cracks
• If the partner is asymptomatic, preventive treatment is useless
• If a man has candidal balanoposthitis for the first time and without an obvious reason, the doctor must check his blood glucose - this is a classic debut of diabetes mellitus
• During treatment and in case of severe inflammation, it is reasonable to refrain from proximity or use barrier protection
• If a woman’s episodes recur, her background conditions should be examined first, rather than prescribing courses of medication for her partner.