Patient's question:
Doctor, I have mild candidal vaginitis, and it has recurred after a period of treatment. What kind of vaginal medication and oral medication works well? Thank you for your answer!Doctor's answer:
Hello, reference materials: Which groups of people are prone to candidiasis? Statistics show that about 10% to 20% of healthy women have white in their vaginas. So under what circumstances do these white multiply and become pathogenic bacteria? (1) extensive use of broad-spectrum antibiotics: usually, many bacteria live in the vagina of women, and these different communities mutually restrain each other, forming a symbiotic state, which is non-pathogenic. The extensive and long-term use of broad-spectrum antibiotics disrupts the vaginal flora, changes the mutual inhibitory effect between them, and allows white to multiply. With the increasing use of antibiotics, the incidence of candidiasis has also increased. (2) pregnancy: during pregnancy, the body's sex hormone levels are significantly higher than usual, which increases the glycogen content in vaginal epithelial cells, increases the acidity of the vagina, and creates an environment conducive to the growth of. At the same time, pregnancy can reduce the immunity of cells, making it easier for to cause disease. Statistics show that 1/3 of pregnant women have in their vaginas, with an incidence of about 15%. (3) diabetes: after suffering from diabetes, the body's sugar metabolism is disrupted, blood sugar levels rise, and glycogen content in vaginal epithelial cells increases, similarly increasing the acidity of the vagina and making it conducive to the growth and reproduction of. (4) use of corticosteroids: long-term use of corticosteroids will reduce the phagocytic ability of white blood cells and reduce the body's immunity; at the same time, corticosteroids can also increase the body's blood sugar levels, increasing the likelihood of developing candidiasis. (5) use of immunosuppressants: it will reduce the body's immunity and make it easier to suffer from candidiasis. (6) use of estrogens: estrogens promote the deposition of glycogen in vaginal epithelial cells. These glycogen are decomposed into lactic acid by vaginal lactobacilli, increasing the acidity of the vagina and creating an environment conducive to the growth of. (7) severe illness that weakens resistance or deficiency of compound B vitamins can also easily cause candidiasis. In addition, some people believe that oral contraceptives can also increase the incidence of candidiasis. Does candidiasis transmit? Although 10% to 20% of healthy women have in their vaginas, and some special circumstances such as long-term use of antibiotics and diabetes can induce vaginal infection, candidiasis can also be transmitted from the outside in many cases. When a woman has sexual contact with a man who has a positive culture for, her infection rate is 80%; about half of the men who have sexual contact with women suffering from candidiasis will be infected. That is to say, candidiasis can be transmitted through sexual contact, which is why when a woman suffers from candidiasis, her partner must also be treated at the same time. In addition, indirect contact transmission is also a way of transmission for candidiasis. Contact with seats of public toilets, bathtubs, bathtubs, towels, unclean toilet paper, etc. can all cause transmission. When the number of in the external genitalia and vagina of the infected person reaches a certain amount, candidiasis of the external genitalia and vagina can occur. What are the clinical manifestations and diagnosis of candidiasis? The most common symptoms of candidiasis are itching of the external genitalia and a significant increase in vaginal discharge. The itching symptoms of patients are sometimes light and sometimes heavy, and they come and go. The itching caused by candidiasis is generally more obvious than that caused by trichomoniasis, and severe itching can make it difficult for patients to sit or lie down and sleep and eat. Patients may also have a burning sensation in the vagina, especially during urination. When the inflammation is severe, symptoms such as frequent urination, dysuria, and dyspareunia may also appear. An increase in vaginal discharge is another main symptom of this disease. Vaginal discharge is generally viscous, white or yellow, or may be thin. The typical vaginal discharge of candidiasis is like curd or milk curd. During gynecological examination, the degree of congestion of the labia minora and vaginal mucosa varies depending on the severity of the condition. The labia minora may be edematous. There is a lot of viscous white discharge in the vagina or a white membrane covering the vaginal mucosa. After wiping off the white membrane, the exposed mucosa is red, swollen, and eroded, or superficial ulcers may be seen. If the symptoms are typical, the diagnosis is not difficult, but laboratory tests should still be combined for confirmation. The commonly used method is the wet mount method: place a drop of physiological saline or 10% potassium hydroxide solution on a microscope slide, take a small amount of discharge and place it on it, and examine it under the microscope directly. If pseudohyphae and spores are found, it means that the is in a pathogenic state, and candidiasis can be diagnosed. If the patient's symptoms are suspected, but pseudohyphae are not found after multiple direct microscopic examinations, bacterial culture should be performed. How to treat candidiasis? Treatment of candidiasis can be treated with pure Western medicine or with a combination of Chinese and Western medicine. (1) general treatment: actively treat other diseases that can cause candidiasis and eliminate susceptible factors. Keep the external genitalia clean and dry, and avoid scratching. Sexual life is prohibited during treatment. Spicy and irritating foods are not recommended. (2) change the pH value of the vagina: the optimal pH value for the growth of is 5.5. Therefore, using alkaline solutions to rinse the external genitalia and vagina and change the vaginal pH value can inhibit the growth and reproduction of. You can use 2% to 4% baking soda solution to rinse the vagina, once or twice a day, with 2 weeks as a course of treatment. After rinsing, dry the external genitalia and keep them dry to inhibit the growth of. (3) vaginal medication: using imidazole suppositories for vaginal medication has a good effect on candidiasis. Clotrimazole suppository, one piece every night, is inserted into the vagina after rinsing, with 10 to 14 days as a course of treatment; or Daktarin suppository, one piece every night, is inserted into the vagina after rinsing, with 7 days as a course of treatment. (4) topical ointment: using clotrimazole ointment or Daktarin ointment externally can treat vulvitis caused by infection and relieve the symptoms of itching and pain of the external genitalia. Apply externally several times a day and use for 2 weeks. Eucerin ointment is composed of econazole as the main drug and a small amount of local steroid treatment agent, with a good anti-itch effect, and is more suitable for patients with candidiasis of the external genitalia and vagina with severe itching and pain. Apply externally, once in the morning and once at night. After the above methods of treatment, the clinical symptoms of patients will improve quickly, but this does not mean that candidiasis has been cured. Patients should insist on completing the treatment course, and then go to the hospital for a review of symptoms, gynecological examination, and laboratory tests of vaginal discharge. If there are no abnormalities, it means that it has been cured recently. After that, you should have the above examination content reviewed once a month after the menstrual period for three consecutive months, and if all are negative, it is considered completely cured. Does the disappearance of symptoms in patients with candidiasis mean recovery? Currently, most of the drugs used to treat fungal vulvovaginitis in clinics are imidazole drugs, which have a good antifungal effect. Therefore, after oral and topical treatment, the symptoms of patients will improve or disappear quickly, but this does not mean that fungal vulvovaginitis has been cured, but that the has been temporarily inhibited. Patients must not stop medication at this point, but should follow the doctor's advice, complete the treatment course (you can stop medication during the menstrual period), and then go to the hospital for a gynecological examination and microscopic examination of vaginal discharge after the menstrual period. If it is negative, it is considered a recent cure. If necessary, further treatment will be provided. Only when the gynecological examination and microscopic examination of vaginal discharge are all normal for three consecutive months can it be considered completely cured. Some patients do not follow the medication rules, and when the symptoms are slightly better, they stop medication on their own. Soon after, the symptoms reappear, and they use medication again for a period of time. Using and stopping medication like this will make the develop drug resistance, affect the efficacy of the drug, and lead to chronic candidiasis, which is difficult to treat, bringing inconvenience to the patient's life and causing mental stress. Therefore, in order to completely cure candidiasis, on the one hand, the doctor should explain the medication method and cure standard in detail, and on the other hand, the patient should insist on treatment and regular review, and not be afraid of trouble. Why is candidiasis prone to recurrence? The reasons that can cause the recurrence of candidiasis can be summarized as follows: First, after the occurrence of candidiasis, if the medication is not serious and cannot be completely treated, it is an important reason leading to the recurrence of the disease. After the treatment of patients with candidiasis, they still need to go to the hospital for a gynecological examination and laboratory tests of vaginal discharge after each menstrual period for three consecutive times. If there is a sign of infection during this period, it cannot be considered cured, but it belongs to recurrence or reinfection and needs to be continued. Second, the two parties of the couple have not received treatment at the same time: after a woman suffers from candidiasis, the pathogen can be transmitted to her husband through sexual life, making her husband a carrier, and about 10% of men can develop balanoposthitis. If only the woman is treated and the man is not treated, even if the woman is cured, she will be reinfected by her husband, and the will be repeatedly "transmitted" between the two parties, and the candidiasis of the woman will recur. Third, not changing and disinfecting underwear and towels according to regulations during treatment can also become a reason for reinfection of. Fourth, the human body itself can be a carrier of. in the intestine can cause candidiasis when they infect the vagina. For example, if the hygiene habits are not good, and the external genitalia are wiped after defecation from the anus to the urethra, the in the intestine may be brought into the vagina, repeatedly causing candidiasis. Therefore, when treating candidiasis, medication should be taken orally to eliminate in the intestine. At the same time, the patient needs to change bad hygiene habits. Fifth, frequent or long-term use of antibiotics repeatedly destroys the balance between vaginal flora and makes grow vigorously. For these patients, antifungal drugs should be given for prevention at the same time as or after taking antibiotics. Sixth, repeated attacks of candidiasis in diabetic patients are due to the increased acidity in the vagina and long-term urinary sugar, which provide favorable conditions for the growth of. Therefore, treating diabetes is the key to reducing the recurrence of candidiasis. Seventh, not paying attention to hygiene, washing underwear with socks. Although it is rare for candidiasis to cause candidiasis through athlete's foot, it is not impossible. If the bacteria that cause athlete's foot are indeed, then the above practice will cause self-infection and lead to candidiasis. In addition, frequently using sanitary napkins and toilet paper with unqualified hygiene standards, or having the habit of washing basins, may also lead to repeated attacks of candidiasis. How to treat recurrent candidiasis? The treatment of recurrent candidiasis should first remove the causes that can lead to repeated infection of in the vagina, prolong the treatment period, and use multiple treatment methods simultaneously. Local treatment can take Chinese herbal medicine fomentation and first, then medication for the vagina, and apply antifungal ointment externally. Local treatment can be carried out throughout the menstrual cycle, and medication should be stopped during the menstrual period, and treatment should continue after the menstrual period; take Sporanox 200mg once a day after meals, and continue for 3 days. Such treatment should be adhered to for 1 to 2 months. Does candidiasis affect the fetus? Pregnant women are a high-risk group for candidiasis. The reasons are: during pregnancy, the sex hormone level rises, which increases the glycogen content in the vaginal epithelium, and the vaginal pH value changes; at the same time, the renal sugar threshold decreases, and the urine sugar content increases. These are all conducive to the growth and reproduction of. Statistics show that about 1/3 of pregnant women have in their vaginas, with an incidence of about 15%, while the rate of in the vaginas of ordinary healthy women is only 10% to 20%. After pregnant women get sick, a few people's in the vagina can go up the cervix and penetrate the fetal membrane to infect the fetus, causing premature birth. In addition, when the fetus is delivered through the mother's vagina, it may also be infected by, mostly causing oral infection, such as thrush, which is usually said to be oral infection. Some infants may also develop around the anus. Therefore, to avoid infecting the fetus, pregnant women with candidiasis should actively treat it. Local medication is appropriate. Why is candidiasis difficult to heal in unmarried women? The treatment of candidiasis in unmarried young women is indeed a bit tricky. Because the patient says she is unmarried, the gynecologist cannot examine the inflammation characteristics of the vaginal mucosa and cannot put special drugs into the deep part of the vagina to kill, only Chinese herbal medicine fomentation and some clotrimazole ointment can be applied to the outside of the vagina. But this method of medication cannot kill in the vagina. This is the reason why long-term treatment has not been effective. In daily life, we often encounter such patients. First, always ask if they have had sexual life, the vast majority of patients can answer honestly; those who have had sexual life will agree to vaginal examination. Once you agree to a vaginal examination, it will be easy to handle, and everything will be treated according to married patients. You can give her 3% sodium bicarbonate solution and nystatin, a total of 10 days of medication, and ask her to use it at home. Every night before going to bed, use 3% sodium bicarbonate solution to rinse or sit in the vagina, wipe dry, and then put one piece of nystatin suppository into the deep part of the vagina. Once a day, for 10 days. Since nystatin is a special drug and is placed in the main site where multiplies and causes inflammation, the effect is very good, and it will be cured after one course of treatment. But to prevent recurrence, you must ask about the condition of the male party, and the two parties must be treated together. If the male has, you can give him 3% sodium bicarbonate solution and 3% clotrimazole ointment, clean the glans with 3% sodium bicarbonate solution before going to bed, wait until it dries, and then apply clotrimazole ointment, once a day, for 10 days. If no lesions are found outside, you can give him0.15g, take it once, and it can clear the hidden in the reproductive tract. This drug affects liver enzymes, so those with abnormal liver function should use it with caution. Avoid sexual life during treatment. Use a condom for the first month after resuming sexual life, and if there is no abnormality, use a condom again. If it recurs after taking off the condom, then review the sexual behavior. The following situations can all lead to recurrence: the male has extramarital affairs, the male has hidden, oral sex, anal sex, etc. If so, it should be changed as soon as possible. If the patient is unmarried and has no sexual experience, vaginal examination cannot be performed, and special long and thin instruments should be used for diagnosis. The central part of the hymen has a hole about the size of a small earring, which is the exit for menstrual blood, and the inside is the vagina. The vagina is about 9 cm long and has many folds. You can use a long and thin cotton swab through this hole into the bottom of the vagina, take bean curd-like white discharge for examination, and find to confirm the diagnosis. The medication is still 3% sodium bicarbonate solution and nystatin, and another open catheter and a 10ml syringe are given to the patient to use at home. The method is: every night to clean the external genitalia with warm water; then insert the catheter through the hole of the hymen into the deep part of the vagina, use a syringe to draw sodium bicarbonate solution from the catheter and inject it into the vagina for rinsing 5～8 times, each time drawing 10ml. The purpose is to rinse a large amount of white discharge and out of the vagina and create an alkaline environment to inhibit the growth of. After rinsing, draw out the remaining liquid in the vagina, wipe dry the external genitalia, and sit on the bed; use a syringe to draw the pre-mixed nystatin solution and still inject it into the deep part of the vagina through the catheter. Withdraw the catheter, lift the buttocks and go to sleep. The nystatin solution can be prepared: take one piece of nystatin suppository, dissolve it in 4ml of cold boiled water, and it is ready. If the external genitalia are affected, you can apply 3% clotrimazole ointment. Once a day, 10 days1；1 cure. To prevent recurrence, you must find the source of infection to cut off the source. Unmarried patients without sexual life belong to non-sexual transmission. Common ways of transmission include swimming, wearing public swimsuits, using public toilets, bathtubs, and swimming pools; dirty hands touching the external genitalia or masturbation; or wiping the in the wrong order, that is, from the back to the front, bringing to the vicinity of the; or washing the lower body first and then the external genitalia, which can all bring from the rectum into the, causing recurrence. Triggers include long-term use of antibiotics, hormones, and diabetes. Occasionally, it can be caused by unclean gynecological examination instruments. If the patient has concerns about this method of medication, such as fear of damaging the hymen, you must explain that the catheter is thin and soft and will not damage the hymen. If you can't operate it, you can demonstrate it to her a couple of times, and she can master it. The catheter and syringe should be washed with cold boiled water and can be reused. Of course，。：，（）2，。Candidiasis is caused by the infection of in the mold. It is more common in pregnant women and diabetic patients. The main symptoms of candidiasis are burning pain in the external genitalia, increased vaginal discharge, and the vagina discharges curd-like or bean curd-like secretions. 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