Vaginal Candida: symptoms, cause and treatment

By Cristiano Antonino Last updated Mar 14, 2023

Vaginal candida (or candidiasis) is an infection generated by mycetes (i.e. fungi) that is very common in women of childbearing age – an estimated 70-75% have developed it at least once in their lifetime – but can also affect men

In the latter, it can present itself either asymptomatically (oropharyngeal cavity, intestines, etc.) or symptomatically (skin and genital mucous membranes).

The asymptomatic variant is 4 times more common in males than in females.

It is possible to isolate candida especially in the coronal groove of the penis and sometimes in the prostatic fluid emitted with the ejaculate

Sexual transmission cannot therefore be excluded, although its frequency is rather low.

Favoured by conditions such as improper use of antibiotics, poor intimate hygiene, pregnancy, immunodepression or diabetes, vaginal candida often causes pain and itching of the vulva, dyspareunia (pain during sexual intercourse) and pain or burning during urination.

Generally, vaginal candida does not represent a serious health condition for the woman affected

An objective examination and history are typically sufficient for diagnosis; however, in some cases, more extensive diagnostic tests such as a vaginal swab, blood test or urine test are also necessary.

Commonly, vaginal candida is treated through the use of antifungal drugs available in cream or as tablets for oral or vaginal use.

Vaginal Candida: symptoms

The most common symptoms seen in cases of vaginal candidiasis are:

whitish vaginal discharge, generally not malodorous, with an appearance similar to cottage cheese or curdled milk
pain and/or itching at the vulva (entrance to the vagina)
discomfort or pain during sexual intercourse (dyspareunia)
burning or pain during urination (dysuria), when the urinary tract is also affected.

In the case of inflammation of the genital area, the following symptoms are also noted

reddening of the vulva and vagina
local swelling
vaginal fissures
extremely painful skin sores (a condition found very rarely).

Recurrent candidiasis

Candidiasis can occur even many months after the first episode, or not at all for the rest of one’s life.

There is, however, a percentage of women – around 5-10% – who develop a recurrent form.

Recurrent vulvovaginitis is defined as vulvovaginitis occurring with a frequency of at least 4 episodes per year.

To treat these recurrent forms, prevention must be implemented, lasting at least six months, with the use of antimycotics by mouth or in ova taken cyclically.

In addition, risk factors (such as diabetes mellitus, oral contraception, too tight clothing, poor hygienic conditions, frequent cycling or motorcycling) should be investigated and carefully assessed.

It is then generally advisable to take certain precautions such as:

adopting a diet low in sugars and yeasts
taking moderate amounts of fructose and honey.

Complications

A recurring candidiasis can be one of the probable causes of a condition known as vulvar vestibulitis (or provoked vestibulinia), capable of generating pain during sexual intercourse, burning or a sensation of a thousand pins, which can worsen and become chronic, also affecting the entire vulva, hence the name vulvodynia.

In addition, if candidiasis affects immunocompromised women or women with particular diseases (e.g. diabetes), vaginal candida can turn into a systemic condition, called invasive candidiasis (or candida).

The latter is the infection resulting from the passage of the fungus Candida Albicans into the bloodstream (fungemia or fungemia) and its spread to important organs, such as the heart (endocarditis), brain (encephalitis), eyes (endophthalmitis) or bones (osteomyelitis).

Invasive candida is to be considered a very serious clinical condition and therefore requires prompt intervention.

Which categories are most at risk of invasive candida? These are typically individuals

those taking immunosuppressive drugs
suffering from AIDS (a disease known to compromise the immune system)
undergoing chemotherapy, one of the side effects of which is a reduction in the efficiency of the immune system
with diabetes mellitus, which facilitates the proliferation of Albicans
who periodically resort to dialysis for kidney failure
who have to undergo insertion of a central venous catheter. The latter is a medical device used in long-term therapy to administer fluids, drugs and other substances needed by the body in the presence of certain conditions.

Causes of candidiasis

Candidiasis arises from an infection by endogenous germs.

It should be noted, in fact, that candida is a fungus whose most common species, called Albicans, is commonly found in low concentrations in the human body, preferring damp environments such as the oral cavity, throat, gastrointestinal tract and genital mucous membranes, without generating any disturbance, in constant equilibrium with the other host microorganisms in our bodies.

In the vagina, together with other bacteria (in larger quantities), in particular Doderlein’s bacillus (also known as lactobacillus), it forms the so-called ‘vaginal ecosystem’.

The correct balance between the various components allows the maintenance of a normal pH (between 3.8 and 4.5) and proper lubrication of the vagina.

Alteration of the vaginal pH (increase or decrease in standard values), by compromising the balance of this ecosystem, favours the proliferation of pathogenic germs.

When, for example, antibiotics are used, the bacterial flora is threatened, leading to the elimination of lactobacilli (the so-called good microorganisms) and the development of colonies of different germs and bacteria.

These lead to the appearance of vaginitis or vulvovaginitis (if the affected area also extends to the external genitals).

Candida does not develop more internally than in the vagina, so it does not affect other areas such as the uterus or ovaries

Fungi that behave like Albicans – i.e. that take advantage of a difficult situation on the part of the host – are known as ‘opportunistic fungi’.

Are there conditions that can facilitate the development of vaginal candida? If so, which ones?

Risk factors for the onset of candidiasis

There are certain elements capable of disrupting the correct functioning of the defence mechanisms that control the proliferation of micro-organisms such as Candida Albicans at the genital level, thus facilitating the manifestation of candidiasis.

These factors include:

diabetes mellitus; high blood sugar facilitates the multiplication of the Candida albicans fungus, as it constitutes an almost inexhaustible source of nutrition for the latter
the use of cortisone and oestrogen-progestins
immunodepression; the immune system is poorly functioning and therefore particularly vulnerable to infection. This is a condition common to AIDS patients, those taking immunosuppressant drugs and the elderly for purely physiological reasons
diseases of the immune system
HIV infections
the typical increase in oestrogen during pregnancy
unprotected sexual intercourse with an infected person
shared use of towels, underwear or soaps with an infected person
antibiotic therapies; in some women with a predisposed vaginal microenvironment, the use of antibiotics can alter the physiological balance between microorganisms and thus facilitate the occurrence of candida.

Some habits to avoid to avoid vaginal candida

wearing tight, tight-fitting clothing
the use of synthetic underwear; the poor transpiration and dampness of the genital area facilitates the proliferation of mycetes
stressful lifestyle
use of aggressive intimate cleansers
poor, or on the contrary, excessive personal hygiene
inordinate consumption of sugar, as this would feed the fungus and facilitate its growth.

Vaginal candida treatment

Treatment of candidiasis must be supported by good rules such as abstaining from sexual intercourse during infection, proper personal hygiene and disinfection of undergarments.

Typically, treatment consists of administering appropriate antimycotics to the patient, either systemic or local (creams or ova), possibly combined with antibiotics.

The most commonly used antimycotics are the azoles, i.e. fluconazole, itraconazole, econazole, isoconazole and so on.

Treatment will depend on whether it is a first episode of candida, or on the contrary a recurrence, or even a failure of an initial treatment.

In the case of recurrent candida episodes, it is essential to detect both general and local predisposing factors and to implement a systemic therapy.

Scientific investigations have shown that itraconazole is the drug of choice in the treatment of vulvovaginal candidiasis due to its high efficacy, good tolerability and broad spectrum activity.

Moreover, it is always advisable to extend the therapy to the partner as well to avoid the so-called ping pong effect.

If, in fact, the woman undergoes treatment and the male partner is unaware of the candida, if he is a candida carrier he will be more likely to transmit it back to his partner during intercourse.

Finally, it is desirable to take milk enzymes to balance the intestinal bacterial flora anatomically close to the genital area.

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