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What is vulvovaginal candidiasis?

Vulvovaginal candidiasis (VVC), also known as a yeast infection, occurs when Candida yeasts overgrow in the vagina and cause inflammation. Vulvovaginal candidiasis affects the vagina and vulva, which is the external part of the female genital organs that include the labia and vaginal opening. Vulvovaginal candidiasis is characterized by itchiness of the vulva and an abnormal, cottage cheese-like vaginal discharge.1,2

Vulvovaginal candidiasis is the second most common cause of inflammation of the vagina (vaginitis) after bacterial vaginosis (BV). Worldwide, VVC affects up to 75% of females during their lifetime.

Recurrent vulvovaginal candidiasis (RVVC) occurs when a female experiences VVC four or more times a year. Recurrent vulvovaginal candidiasis can affect quality of life, mental health, and sexual activity. Less than 5% of females have RVVC.3,4

What are common symptoms?

About 20% of VVC cases don’t have any symptoms,1 though most females experience some or all of these symptoms3,5:

  • Severe vaginal itching
  • Vaginal discharge (white and cottage cheese-like)
  • Vulval burning
  • Vulval soreness and irritation

These symptoms can also be accompanied by pain when urinating or having sexual intercourse.

Vulvovaginal candidiasis symptoms are very similar to symptoms associated with BV, trichomoniasis, and gonorrhea. For this reason, VVC is hard to self-diagnose. A visit to your healthcare provider is important for an accurate diagnosis and proper treatment.6

What are the causes?

Vulvovaginal candidiasis is caused by Candida yeasts. These yeasts are part of the normal human microbiota, particularly on the surfaces of the genital, urinary, respiratory, and gastrointestinal tracts. In healthy individuals, the immune system and lactobacilli maintain the balance of the vaginal microbiota. When this balance is disrupted, Candida may overgrow, leading to a yeast infection.

Candida albicans causes about 80% of candidiasis. Other types of Candida – such as C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei – may cause more severe cases of VVC.6

Risk factors for VVC can be divided into health and behavioral factors, including the following6:

Health factors

  • Diabetes
  • Genetics
  • Immunosuppressive diseases such as HIV or cancer
  • Pregnancy

Behavioral factors

  • An intrauterine device
  • Antibiotic use
  • Frequent sexual intercourse
  • Oral contraceptives
  • Use of spermicides or condoms

How does this topic relate to my microbiome?

Candida is a normal, harmless part of the gut and vaginal microbiota in low amounts, and usually does not cause any symptoms.7

A large proportion of VVC patients also have Gardnerella and a more diverse vaginal microbiome.8 This is significant because, unlike the gut, a healthy vagina has low microbial diversity. That said, there is no consistent bacterial profile in the vaginal microbiome of patients with VVC. In some patients, the vaginal microbiome might look like that of a healthy person, dominated by Lactobacillus. In others, the vaginal microbiome might look similar to that of a person with BV. Vulvovaginal candidiasis is also correlated with particular Lactobacillus species. Overall, though, it is not clear how or what causes Candida to overgrow and cause VVC.9

Which diseases/topics are related to nonalcoholic fatty liver disease?

Vulvovaginal candidiasis is a type of vaginitis, which is a vaginal disorder characterized by infection and inflammation. Bacterial vaginosis and trichomoniasis are other common types of vaginitis. These three disorders account for up to 90% of vaginitis cases. Other causes of vaginitis include vaginal atrophy in postmenopausal women, foreign bodies in the vagina, irritants, and allergens.10

Other diseases that affect the female genitalia include:

  • Aerobic vaginitis
  • Cervicitis
  • Cervical cancer
  • Genital warts
  • Pelvic inflammatory disease
  • Sexually transmitted infections

How can I take action?

You can prevent VVC by11:

  • Avoiding frequent use of vaginal hygiene products and vaginal douches, since they can change the vaginal pH and microbiota. These products are marketed as hygiene products but can actually make VVC symptoms worse.
  • Keeping the external vaginal area dry, and avoiding wearing a damp bathing suit or damp underwear for a long period
  • Wearing loose clothing
  • Wearing breathable cotton underwear
  • Maintaining a healthy, balanced diet that is low in sugar and rich in vitamins

You should never self-diagnose nor self-treat any kind of vaginitis. If you suspect that you have vaginitis, consult your healthcare provider for a physical examination to get a proper diagnosis. A typical treatment for VVC involves oral and/or topical antifungal drugs, depending on how severe it is. Unsupervised use of antifungals may cause yeast resistance to these drugs.12

References

1. Sobel, J. D. (2007). Vulvovaginal candidosis. The Lancet, 369(9577), 1961–1971.

2. Martin Lopez, J. E. (2015). Candidiasis (vulvovaginal). BMJ Clinical Evidence, 2015(0815), 1–39.

3. Cassone, A. (2015). Vulvovaginal Candida albicans infections: pathogenesis, immunity and vaccine prospects. BJOG: An International Journal of Obstetrics & Gynaecology, 122(6), 785–794.

4. Centers of Disease Control and Prevention (2015). Vulvovaginal Candidiasis.

5. Blostein, F., Levin-Sparenberg, E., Wagner, J., & Foxman, B. (2017). Recurrent vulvovaginal candidiasis. Annals of Epidemiology, 27(9), 575–582.

6. Gonçalves, B., Ferreira, C., Alves, C. T., Henriques, M., Azeredo, J., & Silva, S. (2016). Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Critical Reviews in Microbiology, 42(6), 905–927.

7. Bradford, L. L., & Ravel, J. (2017). The vaginal mycobiome: A contemporary perspective on fungi in women’s health and diseases. Virulence, 8(3), 342–351.

8. Liu, M. B., Xu, S. R., He, Y., Deng, G. H., Sheng, H. F., Huang, X. M., … Zhou, H. W. (2013). Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS ONE, 8(11).

9. Vitali, B., Pugliese, C., Biagi, E., Candela, M., Turroni, S., Bellen, G., … Brigidi, P. (2007). Dynamics of vaginal bacterial communities in women developing bacterial vaginosis, candidiasis, or no infection, analyzed by PCR-denaturing gradient gel electrophoresis and real-time PCR. Applied and Environmental Microbiology, 73(18), 5731–5741.

10. Sobel, J. D. (1999). Vulvovaginitis in healthy women. Comprehensive Therapy, 25(6–7), 335–346.

11. Martins, N., Ferreira, I. C. F. R., Barros, L., Silva, S., & Henriques, M. (2014). Candidiasis: Predisposing Factors, Prevention, Diagnosis and Alternative Treatment. Mycopathologia, 177(5–6), 223–240.

12. Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, Jr., D. K., Calandra, T. F., Edwards, Jr., J. E., … Sobel, J. D. (2009). Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 48(5), 503–535.