Patient's question:
Detailed medical condition and consultation purpose: Suffering from candidal vulvovaginitis for 10 years, relieved by various medications but not cured. What to do?Doctor's answer:
Hello: Treatment:a. Eliminate triggers
If diabetes is present, provide active treatment; promptly discontinue broad-spectrum antibiotics and estrogens. Change underwear frequently. Boil used underwear, basins, and towels.
b. Change vaginal pH
Flush the vagina with a 2%–4% sodium bicarbonate solution to create conditions unfavorable for Candida survival.
c. Antifungal agents
After alkaline solution, use the following medications:
c1: Clotrimazole (clotrimazole) suppositories or tablets, once nightly, 1 suppository or tablet each time, inserted deep into the vagina, for 7 days;
c2: Miconazole nitrate (Daktarin) suppositories, 1 suppository nightly inserted into the vagina, for 7 days;
c3: Nystatin (nystatin) suppositories or tablets, once nightly, 1 suppository or tablet (100,000 U) each time, for 7–10 days;
c4: Miconazole vaginal effervescent tablets, 1 tablet nightly inserted into the vagina, for 5 days;
c5: 1% Gentian violet solution for vaginal application, 3–4 times weekly for 2 weeks. The drug is inexpensive and highly effective, but the concentration must be carefully controlled. If the drug is too concentrated or used too frequently, it may cause chemical vulvitis and epidermal erosion. Due to its tendency to stain clothing, it is now rarely used in clinical practice.
d. Treatment for refractory cases
① This condition is often associated with diabetes. If it does not improve with treatment, check for urinary and blood glucose levels.
② It may also be concurrent with trichomoniasis, so check for Trichomonas infection.
③ To prevent mutual intestinal Candida infection, oral nystatin (500,000–1,000,000 U) can be taken three times daily for a 7–10-day course to eradicate it.