The trouble of "tofu dregs"

This is the 3794th article of Da Yi Xiao Hu

Many women will encounter the embarrassment and difficulty in talking about the bean curd-like secretions on their underwear, which are often accompanied by vulvar itching and often occur before menstruation. In severe cases, patients may become restless and their lives and work may be affected. This is the common vaginal candidiasis (VVC) in clinical practice, which is often called candidal vaginitis or candidal vaginitis. About 75% of women have suffered from it at least once in their lives, and the recurrence rate can be as high as 40%~50%.

Candida characteristics:

Candida albicans is divided into Candida glabrata, Candida parapsilosis, Candida tropicalis, etc. They prefer acid and hate alkali, are not heat-resistant, and will die when heated to 60°C, but they have strong resistance to ultraviolet rays, chemicals, and drying. 80%~90% of VVC is caused by Candida albicans, and 10%~20% is caused by other types of non-Candida albicans. Both have high recurrence, but the latter are more stubborn and have poor treatment effects. Candida albicans is a conditional pathogen. Although 10%~20% of non-pregnant women and 30% of pregnant women have this fungus parasitic in their vagina, the amount of bacteria is very small and does not cause symptoms.

Common causes of disease:

1. Pregnancy

2. Diabetes

3. Extensive use of immunosuppressants or immunodeficiency diseases

4. Long-term use of broad-spectrum antibiotics

5. Tight synthetic underwear and obesity

6. Long-term use of contraceptive pills containing high doses of estrogen

7. Candida infection in other parts of the body, such as the intestines, mouth, etc.

Transmission route:

1. Endogenous infection: In addition to the vagina, Candida can also parasitize in the mouth and intestines. The Candida in these three parts can be transmitted to each other and cause infection once the conditions are right;

2. Sexual intercourse;

3. Contact with infected clothing.

Clinical manifestations:

In addition to the characteristic manifestation of leucorrhea being tofu dregs or curd-like, patients often have vulvar itching and burning pain. In severe cases, they may be restless and extremely painful. In addition, some patients will experience symptoms such as dyspareunia, dysuria, and frequent urination.

How to treat:

1. Remove the cause:

1) People with diabetes should monitor their blood sugar regularly and adjust medication in a timely manner if blood sugar is not well controlled;

2) Those who have been using broad-spectrum antibiotics, estrogen, immunosuppressants and short-acting contraceptives for a long time should stop using them promptly;

3) Change underwear frequently, and wash used underwear, basins and towels with boiling water;

4) Pregnant women should seek medical attention promptly.

2. Drug treatment:

1) Treatment: For simple VVC, topical or systemic medications can be used, and the efficacy of the two is similar, with a cure rate of 80%-90%. For recurrent or refractory VVC, whether it is topical or systemic medication, maintenance treatment should be added after the initial treatment, and the treatment time should be appropriately extended;

2) Choice of drugs: Local medication: vaginal preparations such as miconazole, clotrimazole, nystatin, etc., which can be used in combination with alkaline washes to adjust the pH of the vagina; systemic medication: oral preparations such as fluconazole and itraconazole.

Note:

1. If VVC recurs, check whether it is combined with other infectious diseases such as AIDS, Trichomonas vaginitis, bacterial vaginosis, etc.

2. For pregnant women, local treatment is the main method and oral azole drugs are prohibited;

3. If the sexual partner has symptoms, he/she should undergo Candida testing and treatment and avoid sexual intercourse until cured to prevent repeated cross-infection.

Author: Department of Gynecology, Huadong Hospital, Fudan University

Zhu LihongDeputy Chief Physician