Candidal Vulvovaginitis

  • Epidemiologia
    • Vulvovaginite por candida é a causa mais frequente de corrimento vaginal
      • 70-7%% of women at least once during their lives
      • 25% das mulheres adultas são afetadas
      • ~30% das mulher que fizeram tratamento com antibiótico
  • Etiologia
    • Candida albicans é o agente mais frequente
    • 10% da mulheres têm flora normal
    • C. tropicalis e glabrata são menos suscetíveis aos tratamentos
  • Predisposing factors
    • Estrogens
    • Uncontrolled diabetes
    • Corticosteroids/HIV
    • Hormone replacement
    • Pregnancy
    • Antibiotics
    • Oral contraceptives
    • Intrauterine devices
    • Genetic factors
    • Sexual behavior
  • Apresentação clínica
    • Prurido vaginal
    • Corrimento branco espeço
    • Erosões
    • Pode espalhar para o anus e coxas
    • Sintomas geralmente aumentam antes do período
  • Diagnosis
    • Thick discharge, itch, dysuria, swelling, burning pH<4,5 (N 3,5-4,2)
  • Recorrente (contracetivos orais, HIV, foco no tracto gastrointestinal)
  • Classification
    • Uncomplicated
    • Complicated
      • Recurrent vulvovaginal candidiasis
        • At least 3 symptomatic episodes within the previous year
        • Self professed RVVC in 6-9% of women
        • Muitas mulheres com candidiase vaginal recorrente têm atopia. Trantamento com anti-histamínicos e corticoides pode melhorar?
      • Severe vulvovaginal candidiasis
      • Predisposing factors such as diabetes, immunosuppression
      • Non-albicans vulvovaginal candidiasis
        • C. glabrata, C. tropicalis, C. parapsilosis, Sacharomyces cerevisae, other spp
  • Tratamento
    • Azóis tópicos are recommended as first line therapy, regarded as equivalent
    • Fluconazol 150mg 1x is the main oral alternative
      • Cannot be given: interaction due to P450 inhibition, in the first trimester of pregnancy associated with cleft palate and miscarriages
    • Crónico - tratamentos mais longos, perder peso, iogurtes
    • Pregnancy: clotrimazole 1% cream 5 grams nightly for 7-14 days
    • Flotiran → pode ter um componente de dermatite de contacto a antigénios da candida (Dra. Candida Capuchos)
    • If complicated - perform a culture
      • If non-albicans - high fluconazole resistance
        • Nystatin 100.000 units vaginally nightly for a month
        • Boric acid 600mg capsules vaginally nightly for three weeks (may impair fertility and might be embryotoxic, European Chemicals Agency)
        • Amphotericin B 50mg suppositories vaginally nightly 2 weeks