CANDIDA - Dr. F. Erwin Siagian - 16 Juli 2013

8/18/2019 CANDIDA - Dr. F. Erwin Siagian - 16 Juli 2013

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Vulvovaginal candidiasis (VVC)

Louise Oliver

GP Extension Registrar GU Medicine


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Size of the problem

55% of women by mid !s "ave "ad##$ Geiger M& 'oxman (& Gilles)ie (*+ AmJ Pub Hlth ,--5.85/,,012,,03+

U) to 4 of all women at least , lifetimee)isode

53+0 million )er year ,-+3 inmedication costs 'oxman (& et al STDs 2 !!!.27/6!265+


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Consequences

7ot directly life t"reatening but8++ Poor self esteem+ Psyc"osexual )roblems+9tewart :E& *"elan $;& et al

Obstetrics & Gynecology ,--!.76 /352351+ ;rving G et al+ STIs. 74!"#$$4%'

()) Oct. --,!-6 9ocially unacce)table to discuss Often misunderstood


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Causative agent

$+ albicans 352-!%

$+ glabrata 52,!%

Ot"ers/ $+tro)icalis& $+=rusei& $+ =efyr&> 9acc"aromyces cerevesiae ?(rewer@syeastA


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Symptoms

#ulval itc"ing or soreness

#aginal disc"arge

9u)erficial dys)arenuia

External dysuria


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Signs

Eryt"ema

'issuring

7on offensive disc"arge

9atellite lesions

Oedema


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Investigations

GUM setting/

Gram stain or saline microsco)y of

anterior fornix or lateral vaginal walldisc"arge

$ulture

GP setting/

$"arcoal swab for culture


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Classification of VVC9obel B: et al& Am J Obs Gynecol ,--3.178/!62,,+

, $andida colonisation Uncom)licated ##$

6 $om)licated ##$


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1 Candida colonisation

$andida is an o))ortunist )at"ogen 7ormal vaginal flora in many women

C% in longitudinal studyPriestley $B etGenitourin *e+ ,--C.73/623+

Dig"er in )regnancy ?6!20!%A

Positive D#9 for $andida doesn@tdistinguis" between commensal and)at"ogen


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2 ncomplicated VVC

mild

infreuent

non2)ersistent

non2)regnant women


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! Complicated VVC

severe& )ersistent& recurrent ##$ orunderlying "ost abnormality

:ivided into/ , severe vulvovaginal candidiasis

)ersistent non2 albicans infection

6 recurrent vaginal candidiasis


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"reatment

7ational guidelines www+mssvd+org+u= General advice Fo)ical > oral aole t"era)y 3!2-5%

cure rate ?non2)regnant womenA Oral aole t"era)y avoid in )regnancy

> breast feeding :o not treat asym)tomatic $andida

colonisation

http://www.mssvd.org.uk/http://www.mssvd.org.uk/


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"opical therapy( given #V)

$lotrimaole 5!!mg stat< !!mg x 6


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$ral therapy

'luconaole ,5!mg PO stat

;traconaole !!mg PO (: , day


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Choice of therapy

Oral H more acce)table to some

H Iuic=er onset H systemic side effects

H Inot safe in )regnancy

#aginal H messy

H occasional irritation


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Se%ual partner

Grade evidence to s"ow treatment ofasymptomatic male sexual partners

is not required


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&ollo' up

Unnecessary if sym)toms resolve

Fest of cure unnecessary


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Symptoms fail to settle

9evere ##$ 2 re)eat fluconaole,5!mgs after 6 days 9obel B: et al Am J Obs Gyn,e !!,.185/616261-+

I 7on albicans infection

I Recurrent ##$

I ;rritation secondary to to)ical t"era)y I *rong diagnosis


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ifferential diagnosis

Fric"omonas vaginalis

(acterial vaginosis

Der)es sim)lex virus

#ulval disease

$"lamydia

Gonorr"oea


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12 'omen referred 'ith *problem

thrush+ to r avid ,hite at -a'thorn

-ouse. -eartlands -ospital

:7 re2attend

0!%

R##$,-%

Ecema

,%

Ot"er

,3%

#estibulitis

0%

7il of note

6%

7on albicans

0%


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/ 0ecurrent VVC

Researc" area 9)eciated fungal culture

II'($ and random glucose IID;# test only mandatory if ot"er indication 9ym)tom diary 9elf ta=en swabs

H euivalent to doctor


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0ecurrent VVC

I GUM referral

$ould try regime recommended by

M99#: but unlicencedJ 'luconaole PO ,!!mg wee=ly x 1


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Contraception recurrent VVC

*"et"er )ill causes ##$ unclear

:e)oProvera )rotective

H small retros)ective study

H reduced $andida colonisation in)ros)ective study

7or)lant associated wit" reducedincidence of vaginitis


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*lternative+ treatment

:ue to Kovergrowt" of $andida inbowelIIIII

og"urt and lactobacillus acido)"ilus H lactobacillus vaginal flora not )rotective H intravaginal ineffective but soot"ing (issc"o) MP& et al -e+

Ti+sch Genees/ ,-3C.131/,5-2,1,

H yog"urt effective growt" media for $andida

H Oral lactobacilli may be effective Dilton E et al Ann Int *e+ ,--.116/656265C+

H IIato)y mediated ;solauri E et al Am J 0lin -utr !!,.73/0009205!9+Nallioma=i M& et al 1,ncet !!,.357/,!C12,!C-+


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Summary

7o )at"ognomic feature ;tc"ing is only )redictive sym)tom

CANDIDA - Dr. F. Erwin Siagian - 16 Juli 2013

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