Simple vulvovaginal candidiasis

　　The detection rate of candidiasis in the vaginas of asymptomatic healthy women of childbearing age is about 20%, but the amount of the fungus is very small, presenting as a yeast phase and not causing symptoms. Only when the body's and vaginal local immune abilities are reduced, especially when the local cell immunity is reduced, does the fungus reproduce in large quantities and transform into the hyphal phase, causing symptoms of vaginitis.

　　Among Candida species, 80% to 90% of pathogens are Candida albicans, 10% to 20% are Candida glabrata, Candida parapsilosis, Candida tropicalis, and others. Acidic environments are suitable for the growth of Candida, and the vaginal pH value of most women with Candida infection is between 4.0 and 4.7, usually

　　Candida albicans is a conditionally pathogenic bacterium. 10% to 20% of non-pregnant women and 30% of pregnant women have this bacterium in the vagina, but the amount is very small, presenting as a yeast phase and not causing symptoms. Only when the body's and vaginal local immune abilities are reduced, especially when the local cell immunity is reduced, does Candida albicans reproduce in large quantities and transform into the hyphal phase, causing symptoms of vaginitis. Various factors that are easily infected by Candida albicans in the field of gynecology and obstetrics:

　　1. Anatomical characteristics of the female reproductive organs: The internal and external reproductive organs are connected and closely contact the outside world, making them prone to contact with pathogens. The self-defense mechanism of the female reproductive tract is easily damaged by various factors.

　　2. Changes in female endocrine secretions, such as estrogen and progesterone secreted by the ovary, can affect the vaginal pH value, influencing the colonization, germination, proteolysis, and colony transformation of Candida albicans, leading to disease.

　　3. Candida albicans, especially, is a budding yeast that is widely distributed in soil, hospital environments, and can be transmitted through contaminated articles, food, and normal carriers, with the highest carriage rate in the oral cavity at about 80%, followed by the intestines at about 50%, the vagina at 20% to 30%, the skin at 2%, and the oropharynx at 1% to 4%. When the symbiotic balance between Candida albicans and the body is disrupted, it can locally grow and reproduce in large quantities, causing candidiasis, which can affect the skin, mucous membranes, and even the whole body. Considering the anatomical characteristics of the female reproductive organs, which are close to the anus, and due to the high carriage rate of Candida albicans in the normal intestinal tract, women are also prone to infection.

　　4, The complex flora of women's internal and external reproductive organs. Healthy women have dozens of microorganisms in the vagina, which affect the role of lactobacilli in the vagina to exert self-cleaning action, change the vaginal pH value, and easily lead to flora imbalance. This reduces the detection rate of lactobacilli and other Gram-positive bacteria and anaerobic bacteria, while the detection rate of Candida albicans significantly increases, leading to flora imbalance and increased susceptibility to disease.

　　5, Women's unique conditions such as pregnancy, childbirth, sexual intercourse, and decreased immune function lead to disease or cross-infection.

　　6, The influence of clothing and women's hygiene products.

　　7, The widespread and even excessive use of antibiotics has significantly increased the incidence of vulvovaginal candidiasis.

　　8, Maternal infection is prone to contamination of the newborn during childbirth through the birth canal, causing thrush, diaper rash (red buttocks), infection of the eyes, ears, scalp, armpits, and other creases or skin sites. For premature infants, low birth weight infants, and small-for-gestational-age infants, due to their incomplete immune function, and because such infants often spend their first days in an incubator and are frequently treated through various channels, prolonged temperature, humidity, and catheter placement are all factors that make these infants prone to candidal infection.

　　In summary, candidal infection in gynecology is a common and non-negligible disease.

　　Patients with simple vulvovaginal candidiasis are prone to mixed infections with other pathogens and concurrent sexually transmitted diseases, such as AIDS, condyloma acuminata, gonorrhea, and non-gonococcal vaginitis. Simple vulvovaginal candidiasis also increases the risk of infertility. Changes in the vaginal pH can inhibit sperm motility, and inflammatory cells can phagocytize sperm, weaken sperm motility, and cause agglutination of sperm by Candida albicans. Sexual intercourse pain and decreased libido during inflammation can also affect pregnancy. This infertility can be quickly restored after active treatment. If candidal vaginitis is not treated for a long time, it can cause ascending inflammation, leading to cervicitis and cervical erosion. If the pathogen enters the uterine cavity, it can cause salpingo-oophoritis, pelvic inflammatory disease, and finally affect pregnancy.

　　The prevention of vulvovaginal candidiasis should be formulated according to its etiology, specifically as follows:

　　1. Patients with initial Candida albicans infection should be treated thoroughly

　　Candida albicans can grow on the mucosal surface and can also penetrate into the deep layer. If the dosage of medication is insufficient and the duration is too short during infection, it is not easy to completely kill the hyphae and spores, and it is easy to produce drug resistance, thus causing recurrent vulvovaginal candidiasis caused by Candida albicans. Therefore, for initial patients, complete treatment is very important, and local treatment or combined systemic treatment can be adopted, and consolidation treatment can be adopted, that is, re-treatment after 10 days of initial treatment. The standard for complete treatment of initial patients is that the自觉 symptoms disappear, signs return to normal, Candida albicans is negative in the microscopic examination, and the above-mentioned are negative for three consecutive menstrual periods.

　　2. Check for systemic diseases, detect and treat them in a timely manner

　　The most suitable pH environment for the growth of Candida albicans in the vagina is 4-5. When various factors cause an increase in glycogen in the vagina, an increase in acidity is most conducive to the reproduction of Candida albicans and the onset of inflammation. During diabetes, the blood glucose level increases, the local glycogen content in the vagina increases, thus changing the normal pH value inside the vagina, forming an internal environment conducive to the growth of Candida albicans and causing infection. On the other hand, diabetic patients have multiple defects in white blood cell function, which are prone to bacterial infections, and the use of antibiotics is also likely to induce candidal vaginitis. Therefore, blood glucose should be checked, and for diabetic patients, blood glucose monitoring should be strengthened to control blood glucose within 6.11-7.77 mmol/L. If the ideal blood glucose level cannot be achieved after dietary treatment, diabetes should be treated with medication, through systemic treatment to restore the local vaginal environment to a normal state, which is not conducive to the growth and reproduction of Candida albicans.

　　3. Improve the local vaginal environment

　　The most suitable temperature for the growth of pathogenic Candida albicans is 37°C, and an increase in local environmental temperature is more conducive to the growth of Candida albicans. In addition to the low systemic immune function during the menstrual period, changes in vaginal pH, humidity, and increased temperature are more likely to lead to secondary candidal infection.

　　4. Enhance the body's immunity

　　Vulvovaginal candidiasis caused by Candida albicans is both a localized disease and a systemic disease, that is, Candida albicans is a conditionally pathogenic bacterium, which causes the host to become pathogenic when the host's resistance and immunity are low. Gamma interferon can inhibit the production of PGE2 by macrophages, thereby inhibiting the formation of spores, germination, and growth of fungi. Therefore, for patients with low immunity due to certain diseases, such as long-term use of immunosuppressants, gamma interferon can be used to prevent candidal inflammation. The immune function of the body also changes during the menstrual period, and it is easy to develop candidal infection, so more attention should be paid to rest.

　　5. Strictly control the use of antibiotics

　　The use of antibiotics is a short-term risk factor for vulvovaginal candidiasis caused by Candida albicans, and long-term use is a direct cause of the increasing prevalence of vulvovaginal candidiasis. Therefore, when there is infection in any system, the indications for the use of antibiotics should be strictly controlled, especially the use of broad-spectrum antibiotics should be paid more attention to, and medication should be stopped in a timely manner. If necessary, oral antifungal drugs should be taken to prevent secondary vulvovaginal candidiasis caused by Candida albicans.

　　6. Advocate for simultaneous treatment of infected women and their sexual partners

　　假丝酵母菌外阴阴道炎是一种性传播性疾病，假丝酵母菌外阴阴道炎患者的性伴其口腔、精液及阴茎冠状沟内均有一定比例的假丝酵母菌阳性率。临床上对性伴也治疗者，其复发率明显低于性伴不治疗组，治疗组复发率也低（治疗组复发率为15.8％，未治疗组复发率为44.8％）。特别是对有口交者有必要对患者的性伴精液及口腔分泌物进行假丝酵母菌培养及菌种鉴别，单纯治疗女方，男方也易交叉感染，采用避孕套可减少性伴间的交叉感染。

　　7、生物制剂应用及含嗜酸乳酸菌的乳制品摄入

　　具有治疗特性的生物制剂如嗜酸乳酸菌不仅能预防婴儿腹泻，抗生素腹泻，同时也可预防假丝酵母菌性外阴阴道炎及肠道感染，无明显副反应，从而减少对抗真菌药物的依赖性，因此，对易感染假丝酵母菌的患者可试用此生物制剂，其作用可能是恢复正常的菌群比例。

　　总之，假丝酵母菌外阴阴道炎的发生是多因素，预防也应个体化，针对各自相应环节采取相应措施，从而减少复发或预防感染。

　　单纯性外阴阴道念珠菌病应做菌种鉴别及pH值测定等检查，具体如下：

　　1、直接检查法

　　直接检查法是临床最常用检验方法，阳性检出率为60％。其优点是简便、快捷。用较长的消毒棉拭子取阴道、宫颈分泌物或阴道壁上乳白色薄膜，作为待检标本。

　　2、革兰染色法

　　此方法阳性检出率为80％。取分泌物涂片，固定后，革兰染色，置显微镜下观察，可见成群革兰染色阳性的卵圆形孢子和假菌丝。刚果红染色或PAS染色法染色后镜检，其阳性率均比直接镜检法高。革兰染色，孢子和假菌丝染成兰色：刚果红和PAS染色，孢子和假菌丝则染成红色。

　　3、培养法

　　如疑为假丝酵母菌性阴道炎，多次检查均为阴性，可作真菌培养。通常，如果患者有典型的临床表现，且在显微镜下见到芽胞和假菌丝即可做出诊断，不需再作培养，以减少不必要的有关费用支出。但是，由于显微镜检查并非是一种很敏感的方法，因此也常需作真菌培养来确诊。

　　4、菌种鉴别

　　实验如需确定分辨假丝酵母菌的种类，必须进行发酵试验、同化试验，并就其菌落形态特征进行鉴别。

　　5、pH值测定

　　pH值测定具有重要鉴别意义，若pH值4.5，并且涂片中有多量白细胞，则提示有滴虫或细菌性阴道病的混合感染。

　　单纯性外阴阴道念珠菌病患者除了一般治疗外，还可以通过食疗的方法来缓解症状。

　　1. Mixed Fresh Lotus Root

　　20 grams of mung beans, 300 grams of fresh lotus root, and 3 fresh mint leaves. Wash the fresh lotus root clean and peel it, soak the mung beans in water to soften them, then insert them into the holes of the lotus root, steam and slice them, chop the fresh mint, sprinkle it on top, season it, and eat it cold.

　　2. Stewed Pork Intestines with Mung Beans

　　Take a certain amount of pork intestines, mung beans, and patrinia, cook the mung beans for 20 minutes, put them into the pork intestines (tighten both ends) and patrinia together, and cook them until they are done, then add seasonings to eat.

　　3. Seaweed and Mung Bean Soup

　　Take a certain amount of seaweed (chopped), mung beans, and sugar, add water to cook the soup and eat it, once a day, for 10 consecutive days.

　　For simple vulvovaginal candidiasis, symptomatic supportive treatment should be given, and if diabetes is present, active treatment should be given. Promptly discontinue broad-spectrum antibiotics, estrogens, and corticosteroids. Change underwear frequently, and rinse used underwear, basins, and towels with boiling water. The following are the drug treatments

　　1. Imidazole

　　Imidazole is a class of antifungal drugs that have developed rapidly in recent years. Most are used locally, with definite efficacy, few side effects, but a high recurrence rate. Among imidazole drugs, clotrimazole and thiocanazole are the clinical first choices due to their significant efficacy and few side effects.

　　1. Clotrimazole: Is commonly used for single-dose vaginal administration of clotrimazole.

　　2. Ketoconazole: Is a broad-spectrum antifungal drug, characterized by good gastrointestinal absorption after oral administration. It has a better effect on Candida albicans than miconazole. Ketoconazole is convenient to use, with definite efficacy, but its side effects are significant, mainly liver toxicity.

　　2. Triazole

　　1. Terconazole: Is limited to local application for the treatment of candidal vaginitis.

　　2. Itraconazole: Has a broad antifungal spectrum and is absorbed quickly after oral administration. Common adverse reactions include gastrointestinal discomfort, headache, itching, and rash, etc.

　　3. Polyene

　　This is a class of antifungal drugs that were applied early in clinical practice and are still widely used today. Among them, nystatin, nystatin, and miconazole have a strong effect on Candida albicans.

　　4. Vaginal irrigation

　　Wash the vulva and vagina with 3% sodium bicarbonate solution or 1:5000 gentian violet solution once or twice a day. Wash the vagina and vulva with 2% soda water once a day, and 10 times for a course of treatment. Generally, after washing the vagina, medication should be inserted into the vagina.