Candidiasis (Moniliasis) is an infection caused by yeast-like fungi. Although infection of the mucous membrane (such as vagina, mouth) predominates, more widespread and deep-seated infection involving internal organs can occur.

CLINICAL FEATURES

The most common symptom is vulval pruritus. Vaginal discharge is commonly minimal and may be cottage cheese-like or sometimes watery. Vaginal soreness, irritation and dyspareunia may be present. There is typically pre-menstrual exacerbation of symptom.

Physical examination reveals erythema and swelling of the labia and vulva. Vaginal mucous membrane is inflamed with adherent whitish discharge.

In male, candidal balanoposthitis is commonly sexually acquired and the incidence is much lower than VVC. It is characterised by the presence of superficial red erosions and thin-walled pustules. Most patients are uncircumcised, as the foreskin provides an occlusive, warm environment for pathogenesis.

TREATMENT

1) General measure

Advice should be given on the washing and disposal of underwear, and avoidance of contamination from the perianal region at defecation. The wearing of cotton as opposed to tight nylon underwear should be encouraged. The male partner should be treated if there is evidence of candidal balanoposthitis.

2) Topical treatment

Vaginal pressaries are frequently employed in the treatment of VVC

a) Polyene antifungal antibiotics
    Nystatin (Mycostatin): 1-2 vag tab nocte x 7-14 days

b) Imidazole antifungal antibiotics

Isoconazole (Gyno-Travogen): single dose with 2 vag tabs to be inserted deeply into the vagina
Clotrimazole (Gyne-lotremin): 1 vag tab nocte x 6 days
Tioconazole (Gyno-Trosyd): 1 vag tab nocte x 3 days

c) Other vaginal pressaries with anti-candida activity includes

Ginetris: 1 vag tab nocte x 6 days
Talsutin: 1 vag tab nocte x 7-14 days

Antifungal cream may be used for vulval candidiasis, balanoposthitis or skin lesion e.g. Mycostatin, Travogen, Trosyd, Lotremin cream.

3) Systemic therapy

Oral medications can be given in resistant or frequent relapse cases.

Itraconazole (Sporanox) 200 mg bd x 1 day or 200 mg qd x 3 days
Fluconazole (Diflucan) 150 mg (single dose)
Ketoconazole (Nizoral) 400 mg qd x 5 days

 

CANDIDIASIS IN HIV-INFECTED PATIENTS

Immunocompromised patients are prone to candida infection. Oral candidiasis and VVC is common in patients with HIV infection. Systemic antifungal is required if topical therapy fails.

Candidiasis of bronchi, trachea, or lung & candidiasis of oesophagus are indicator diseases for AIDS. Systemic antifungal agents is required for the treatment

 

M.S