Vulvovaginal candidiasis: Clinical sciences

Vulvovaginal candidiasis, or VVC, is the second most common form of vaginitis, after bacterial vaginosis. It is the result of inflammation of the vagina and vulva due to infection with yeast, most commonly by Candida albicans. Now, asymptomatic colonization of the vagina with Candida species is common. However, when these species overgrow and invade the epithelial cells of the vagina, inflammation occurs.

Your first step in evaluating a patient who presents with a chief concern suggesting vulvovaginal candidiasis is a focused history and physical exam. Patients typically report an abnormal vaginal discharge, as well as vaginal itching. They may also describe vulvar symptoms, such as itching, pain, redness or swelling. Other symptoms might include dysuria; or dyspareunia, which is pain during sex.

When taking history, be sure to ask about any risk factors. First up, there’s the recent use of medications like broad spectrum antibiotics, which can alter the vaginal flora and allow Candida to overgrow. Next, ask if they have recently treated their symptoms with over the counter medications. Many patients successfully treat VVC with over the counter antifungals. However, when patients present with incomplete or partial treatment, it can be more difficult to make a clinical diagnosis. Finally, the medical history should also include questions about underlying medical risk factors for VVC, such as a history of diabetes or immunosuppression, which may include conditions like HIV, or patients on systemic corticosteroids.

Here is a clinical pearl! VVC is uncommon, before puberty, and in postmenopausal patients who are not using hormone replacement therapy, because Candida species are unlikely to proliferate in the vagina in the absence of estrogen.