Vaginal yeast infection
| Classification according to ICD-10 | |
|---|---|
| B37.3 + | Candidiasis of the vulva and vagina |
| ICD-10 online (WHO version 2019) | |
As a vaginal yeast infection or vaginal mycosis is called an infection of the vagina with mushrooms . Colloquially it is simply referred to as vaginal fungus . It is almost always caused by the yeast Candida albicans or close relatives of the Candida genus . The disease is also called Vaginalsoor or Soorkolpitis designated or (if the vulva affected as is) as vulvovaginal mycosis or vaginitis Candidomycetica .
In the ICD-10 they are classified as B37.3 under the candidiasis .
causes
As part of the vaginal flora, fungi are permanent residents of the vagina and intestines . As saprobionts, they are generally harmless to the body and colonization with yeasts usually does not require therapy outside of pregnancy. Under certain conditions, however, a type of fungus , usually species of the Candida strain (Candida non-albicans species are rare, especially in acute vulvovaginal mycosis), can multiply quickly and cause an infection called candidiasis . This increase is made possible by neutralizing the vaginal pH. Possible causes for a change in the pH value are weakened immune systems , stress , hormone fluctuations , tight and air-impermeable clothing, mechanical stress on the vaginal mucosa during sexual intercourse , weakly alkaline sperm , incorrect intimate hygiene , some underlying diseases such as B. diabetes or certain drugs , especially after antibiotic therapy, which damage the natural vaginal flora.
Statistically, three out of four women will have a vaginal yeast infection at least once in their lives. The trigger is not always clear. The pH value in the vagina of a healthy sexually mature woman is between 4 and 4.5, i.e. in the acidic range. However, it can vary slightly depending on the woman's cycle phase. This milieu, which is maintained by the lactic acid bacteria , is unfavorable for fungal growth .
Symptoms
Typical signs of a vaginal fungal infection are a white discharge from the vagina that crumbles noticeably when rubbed and is largely odorless , combined with itching of the vulva . Often there are white deposits on the vaginal mucosa that cannot be wiped off, known as thrush, which in severe cases spread over the vulva. In addition, erosions of the sensitive skin of the genitals can occur. The changes can also affect the mons pubis and the areas of skin adjacent to the vulva, e.g. B. the inner thighs, expand and lead to pustular or eczema-like lesions there. Associated with soreness, there may be pain during intercourse and painful urination . The symptoms are similar to a bacterial vaginal infection ; there are also mixed infections caused by fungi and bacteria.
Diagnosis
The microscopic examination of a native preparation already allows a diagnosis in many cases. However, in 20–30% of cases the native preparation can be normal. Therefore, if the microscopic findings are unclear or negative, a fungal culture is indicated. A fungal culture is also necessary if pathogens other than Candida albicans are suspected .
treatment
Therapeutic measures for the treatment of persistent or frequently recurring vulvovaginal fungal infections in particular are usually carried out by a gynecologist . Depending on whether an uncomplicated acute infection, a complicated acute infection or a recurrent or chronic infection is present, different therapy plans come into question. Antifungal agents and fungicidal vaginal suppositories , tablets and ointments are local therapy available ( amphotericin B , ciclopirox , clotrimazole , econazole , miconazole , natamycin , nystatin , oxiconazole ). A one-time systemic therapy with fluconazole is also possible. In the case of frequently recurring or therapy-resistant infections, a systemic treatment with orally administered drugs is necessary in the case of vulvovaginal mycoses. With therapy, the symptoms of the infection usually subside after a few days. Co-treatment with the partner is no longer generally recommended for acute vaginal fungal infections. In cases of frequently recurring infections, however, co-treatment can be carried out in order to avoid the risk of mutual re-infection. However, since the fungi are part of the normal skin and intestinal flora in almost everyone, a new infection cannot be ruled out.
Common methods of self-treatment include acidic tablets, lactic acid bacteria or Döderlein preparations in the form of capsules, gels or suppositories from the pharmacy. However, its effectiveness in treating an existing infection is controversial. The natural yogurt introduced into the vagina, often mentioned as a home remedy, can at best briefly alleviate the symptoms. However, since the pH value is not brought into the acidic range required for the Döderlein bacteria to grow, the infection continues. However, yogurt treatment is rejected by most gynecologists because yogurt is physiologically not found in the vagina. Buttermilk was also promoted as a home remedy for a long time. But since dairy products have almost exclusively been heat-treated on the market in Germany for decades, these home remedies no longer have the effect that was ascribed to them in great-grandmother's time. Nevertheless, they have been popularly preserved. The results of clinical studies looking at lactobacilli as an alternative treatment method are mixed. The protection of the healthy vaginal flora with special Döderlein preparations and local measures to maintain the acidic environment can be attempted if fungal infections often occur after sexual intercourse or other specific incidents such as swimming pool or sauna visits. Contrary to popular belief, you cannot get infected with vaginal fungus in toilets, swimming pools or saunas. The reason for the temporal connection with the complaints is to be found in the temporary neutralization of the vaginal pH value by chlorinated water, flushing out of the acid and the like.
In the case of recurrent infections, the antifungal therapy should be supplemented by a reduction in risk factors (blood sugar control in diabetics, experimental omission of oral contraceptives).
prevention
A number of measures are considered to be effective in preventing fungal infections of the vagina, such as avoiding soap , shower gel , body lotion, bath additives, intimate spray etc. in the genital area, in particular avoiding direct contact with the vaginal mucous membranes. The active washing substances and the alkaline to weakly acidic pH value (so-called "pH-neutral" washing lotions with a pH of 5.5) can destroy or wash out the naturally existing microbial colonization of the vagina and impair the natural acidic environment. Special washing lotions for the genital area based on lactic acid with a pH value of 3.5, which increases to the physiological value of 4 to 4.5 when used, are suitable for cleaning the external genitals; cleaning the vagina is usually not necessary .
Hygiene measures also include avoiding the introduction of Candida germs into the vagina; for example through proper cleaning after a bowel movement, as candida is a common and usually harmless inhabitant of the intestine.
Laundry made of air and water vapor permeable (so-called “breathable”) materials such as silk , cotton and viscose and the largely renouncement of liner liners with plastic film counteract a build-up of heat and moisture, which would promote the multiplication of germs.
Contraceptive preparations (foam suppositories, sperm- killing creams) or lubricants placed in the vagina can irritate the vaginal mucous membrane and make it more susceptible to infections, so changing the preparation or choosing another method should be considered.
The preventive use of drugs that contain lactic acid or Döderlein bacteria should maintain and strengthen their natural defense function against pathogenic germs by stabilizing the physiological vaginal flora , especially in women who repeatedly suffer from fungal infections .
For the preventive treatment of recurrent bacterial vaginal infections, three vaccinations with killed, inactivated germs from eight specified Lactobacillus strains (trade name "Gynatren") are available.
contraception
The used to treat and prevent drugs , substances (eg. As fats) that the contraceptive effect of condoms or diaphragms made of latex may interfere. Fats and oils can cause damage such as cracks and holes in these objects, which is why simultaneous use with corresponding creams, ointments or vaginal suppositories should be avoided.
See also
literature
- Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 254-258 ( vulvovaginal mycoses ).
Web links
Individual evidence
- ↑ Werner Mendling: Diagnostics of vaginal mycoses . In: Hans-Jürgen Tietz (Ed.): Skin and vaginal mycoses . Georg Thieme, Stuttgart 2001, ISBN 3-89412-474-1 , p. 86-94 .
- ↑ see e.g. B. Pirotta et al. In: British Medical Journal . 2004; 329 (7465), p. 548. PMID 15333452 and Hilton et al. In: Ann Intern Med . 1992, 116 (5), pp. 353-371. PMID 1736766 .
- ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: Gynatren vaccine: Successful therapy for recurrent colpitis. November 23, 2001. Retrieved February 20, 2019 .
