Fungal vaginitis (or vaginal candidiasis) is caused by inflammatory changes in the vaginal epithelium and vulva epithelium following infection by fungi of the genus Candida, most commonly Candida albicans. Candida is part of the normal vaginal flora in many women (vaginal microbiome) and its presence, usually in small numbers, is often asymptomatic. Therefore, the diagnosis of vulvovaginitis requires both the presence of Candida in the vagina and the appearance of symptoms such as irritation, itching, dysuria, or other symptoms of inflammation.
Vaginitis is generally a very common condition for adult women and is uncommon in girls before adolescence. Bacterial vaginosis accounts for 40-50% of all cases of vaginitis, vaginal candidiasis 20-25%, and trichomoniasis 15-20%. Fungal vaginitis is responsible for almost one-third of all cases of vaginitis in women of childbearing age, while 70% of women report having vaginitis at some point in their lives. About 8% of women suffer from recurrent fungal vulvovaginitis.
The most common pathogen is Candida albicans (91% of cases) while most of the other cases are caused by the species Candida glabrata (7%). Other rarer species of Candida that cause vaginitis are C. parapsilosis (1%) and C. tropicalis (1%). Candida fungi in the vagina are believed to originate from the gastrointestinal tract but there are also scientific objections to this theory.
Recognized risk factors for fungal vulvovaginitis include use of estrogen (contraceptives), increased production of endogenous estrogens (from pregnancy or obesity), diabetes mellitus, immunosuppression (patients undergoing chemotherapy, with HIV infection or transplant patients), and the use of broad-spectrum antibiotics. Although vaginitis is more common in women who are sexually active, there is no indication that the fungal infection is sexually transmitted. Patients with recurrent fungal vulvovaginitis (i.e., 4 or more episodes of laboratory-proven vaginitis) may have some genetic predisposing factors that make them prone to recurrent fungal infections. In men, Candida infection appears as a transient rash or erythema with itching or burning sensation in the penis that occurs within minutes of unprotected sex. The symptoms are self-limiting and often disappear after a shower.
Vulvovaginitis occurs when the fungus penetrates superficially into the vaginal mucosa and causes an inflammatory reaction. The predominant inflammatory cells are typically polymorphonuclear cells and macrophages. Patients may experience an increase in vaginal discharge, which is usually thick and sticky, have discomfort, itching, burning sensation in the vagina, dyspareunia (pain during intercourse), or edema. Symptoms may become more severe before menstruation.
The lack of specific symptoms and signs of the disease makes it very difficult (or impossible) to diagnose based only on history and gynecological clinical examination. Clinical signs and symptoms alone should not be considered a sufficient presumption for diagnosis (only 38% of cases of fungal vaginitis can be accurately identified in this way). Many infections, as well as non-infectious inflammations, can have similar signs and symptoms and therefore laboratory confirmation is necessary.
In Diagnostiki Athinon, the test for the presence of yeasts of the genus Candida in the urogenital system can be done individually with molecular testing, while additionally it is tested in combination with other microorganisms in the following laboratory tests:
- FemoScan® Comprehensive
- FemoScan® Screen
- Vaginal Smear, Microbiological Examination (with cultures)
- Urethral Smear (Male), Microbiological Examination (with cultures)
In addition, the test of Candida yeasts and the infections they cause can be analyzed with the following laboratory tests:
- Candida albicans, Serology Profile
- Candida albicans, Antibodies IgA
- Candida albicans, Antibodies IgG
- Candida albicans, Antibodies IgM
- Candida albicans (M5), IgE
- EnteroScan® Candida
It is also included as a separate test in all EnteroScan®.