Every woman has encountered manifestations of fungal vulvovaginitis (thrush) at least once in her life. In a third of the fair sex, this problem becomes chronic, despite the sufficient depth of knowledge of this issue. Read on Goodshapetips, is it possible to cure thrush forever, and also why do we face problems in its treatment?
Modern methods of disease detection
Factors predisposing to the development thrush, include:
taking, especially long-term, a number of drugs:
- antibiotics,
- corticosteroids,
- oral contraceptives;
the use of intimate gels, lubricants and condoms;
the presence of common diseases:
- severe infectious diseases
- endocrine disorders,
- immunodeficiency states.
Recently, data have appeared that chronic recurrent thrush does not develop in everyone, but only in individuals with certain features of immunity and individual response to the pathogen.
It is an erroneous opinion that tight clothing, wearing thongs, the use of disposable pads, the use of tampons, the use of sweets (carbohydrates), frequent changes of sexual partners, and frequent sexual intercourse also provoke the occurrence of thrush.
The following clinical forms are distinguished:
one. Carrier: the absence of clinical manifestations of the disease, can turn into a clinically delineated form.
2. Acute course (no more than 2 months): pronounced inflammatory changes in the mucous membranes, abundant curdled discharge.
3. chronic course characterized by a disease duration of more than 2 months, during the year 4 or more clinically pronounced episodes are recorded: mild hyperemia and infiltration of the mucous membranes, scanty whitish films, erosion, cracks in the vulva and vagina.
4. Generalized flow: Spread infections to other organs and systems.
Treatment of thrush: what is outdated?
It turns out that yeast-like fungi known to us Candida albicans causes thrush in only 84% of cases.
In other cases, the cause of thrush is other fungi of the genus Candida (non-albicans): C. glabrata, C. tropicalis, C. guillermondi, C. parapsilosis, C. krusei, C. pseudotropicalis, etc. The proportion of these pathogens in the etiology of thrush for has almost doubled over the past 10 years. Most of them are resistant to traditional antifungal drugs.
In addition, scientists in recent years have isolated fungal vulvovaginitis caused by pathogenic fungi Torulopsis, Trichosporon, Malassezia (Pityrosporym orbiculare), dermatophytes Trichophyton, Microsporum, Epidermophiton, filamentous opportunistic fungi Scopulariopsis, Altermania, Acremonium, Aspergillus, Fusarium.
The concomitant gynecological infection also complicates the diagnosis and course of the disease. In my experience, 80% of patients with symptoms of thrush have a mixed bacterial-fungal-trichomonas flora of the vagina.
At present, the usual diagnosis of fungal vulvovaginitis, which is reduced to microscopy of a vaginal smear and, in rare cases, to culture with the release of fungi of the genus Candida, is not enough.
What should a modern examination for thrush include?
one. Establishing the type of pathogenic fungi: Candida or other species. When detecting fungi of the genus Candida, it is necessary to determine their variety (C. glabrata, C. tropicalis, C. guillermondi, C. parapsilosis, C. krusei, C. pseudotropicalis, etc.), which is important for choosing a treatment.
2. Quantification of pathogenic fungi. To do this, the number of yeast colonies isolated from the vagina is counted and assessed whether it is enough for development candidiasis.
3. Identification of the sensitivity of the isolated species of fungi to antifungal drugs.
How to prevent relapses?
Over the past 10 years, the treatment of thrush has changed significantly. Some approaches previously practiced in the treatment of recurrent fungal vulvovaginitis are now recognized as unreasonable. Among them:
local use of a 5-10% solution of borax in glycerin is considered obsolete due to inefficiency;
use of special diet, eubiotics, as well as bowel cleansing for the treatment of intestinal dysbacteriosis, are recognized as optional;
the use of special intimate hygiene products, douching to prevent thrush can lead to washing out of normal microflora.
Currently, drugs for the treatment of fungal vulvovaginitis are divided into the following groups:
The following routes of administration of antifungal agents are distinguished:
- local (use of vaginal suppositories, tablets, creams, solutions);
- systemic (oral, intravenous).
Modern approaches to the treatment of thrush depend on its clinical course.
For the treatment of acute forms of the disease, the use of topical antimycotic agents is usually sufficient, or a single dose of fluconazole (Medoflucon, Diflazon, Diflucan, Mikosist, Forkan, Flucostat) is possible – 150 mg orally.
In chronic forms, it is most advisable:
-
combine therapy with systemic and local antimycotics;
-
increase the therapeutic regimen, conduct an initial course of systemic therapy, and then repeat a course of prophylactic therapy to prevent relapse within 6 months;
-
carry out correction of predisposing conditions: chronic infectious and other diseases, diabetes mellitus, immune disorders.
Thrush in pregnant women
Insufficient effectiveness of therapy for thrush is noted:
with concomitant genital infection;
with chronic forms of diseases, occurring against the background of diabetes mellitus, endocrine disorders and immunodeficiency;
with the emergence of resistance of fungi to antimycotic drugs. This is due to the deep penetration of fungi into the cells of the stratified epithelium of the vagina, in which the pathogen can live for a long time and even multiply, being absolutely protected from the action of drugs;
with insufficient dosage and duration of treatment;
in case of contact allergic vulvovaginitis, which often develops against the background of local treatment (for example, “Clotrimazole”).
one. Monitor gynecological health, detect and treat genital infection.
2. Maintain physical health and emotional status.
3. When using antibiotics in connection with the treatment of any infectious diseases, be sure to take systemic antimycotics – “Diflucan” once 150 mg.
4. If you use lubricants (lubricants) during intercourse, then use only water-soluble types. Do not use creams and other fat-containing products.
five. If you have an allergic reaction to latex condoms, use polyurethane products.
6. Be sure to use a condom if you have casual sex.
During pregnancy, the microflora of the vagina changes under the influence of hormonal changes, which contributes to the reproduction of pathogenic fungi.
Thrush during pregnancy should be treated carefully and under medical supervision. The use of antifungal drugs in pregnant women is limited due to their toxicity.
it is preferable to use topical therapy; recommended drugs – “Isoconazole”, “Clotrimazole”, “Miconazole”, “Natamycin”;
drugs are recommended to be prescribed for a period of not more than 7 days;
the use of systemic drugs (Diflucan, Levorin, Nizoral, Clotrimazole, etc.) during pregnancy is contraindicated.
Candidiasis (thrush) in men can be the result of both uncontrolled reproduction of their own fungi, and their introduction during intercourse from a partner. With any method of occurrence of the disease in men, the reduced resistance of the body plays a decisive role.
Pathogenic fungi in men cause inflammation of the head of the penis and foreskin. At the same time, a curdled discharge with an unpleasant odor appears on the head of the penis.
The glans penis and foreskin become swollen, itching and pain are noted. Sometimes men have a rash on the penis, areas with erosions. In some cases, inflammation of the urethra provoked by candidiasis occurs.
Before starting treatment, it is very important to determine its cause, identify existing endocrine and infectious diseases, and replace drugs that provoke the development of candidiasis.
Therapy of candidiasis in men is not difficult. Usually this is either local treatment (treatment of affected areas with ointments), which should be carried out for 7 days twice or thrice a day, or taking Diflucan once at a dose of 150 mg. In chronic forms of candidal balanoposthitis, repeated courses of systemic therapy are recommended.
If a man does not have clinical manifestations of candidiasis and no pathological fungi are found during the examination, he does not need to be treated, even if a woman has a chronic course of thrush.
Olga PANKOVA,
gynecologist
Photo: shutterstock.com
