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admin | Natural Treatment Bacterial Vag | 20.11.2014
Vulvovaginal yeast infections are very common, medically trivial but sometimes symp-tomatically miserable infections. The majority of vulvovaginal yeast is produced by Candida albicans, but an increasingly large proportion of yeast infections involve Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Candida lusitaniae, Saccharomyces cerevisiae, or even less common organisms (44). The symptoms and clinical abnormalities of vulvovaginal candidiasis are extremely variable. The differential diagnosis consists of several of the diseases characterized by itching, redness, and fissuring. Figure 17 (See color insert) Vulvovaginal candidiasis can produce redness, edema, and fissuring. Figure 18 Candidiasis of dry, keratinized skin such as the labia majora and crural creases is manifested as very superficial and fragile pustules that rupture almost immediately, leaving desquamating collarettes. The diagnosis can be suspected by the history and physical examination, but this should be confirmed by microscopic examination or culture. Although some clinicians and patients believe that diet, use of oral or vaginal lactobacillus supplements, and special disinfecting of underwear can minimize or treat vulvovaginal candidiasis, there are no data to support these beliefs (50,51).
Variable from no abnormalities on examination to vulvar erythema, edema, scale, collarettes, vaginal redness.
Most women and many physicians rightly or wrongly attribute nearly all vulvovaginal symptoms to vulvovaginal candidiasis. Because the colon is a natural reservoir for yeast, occluded, moist, warm anogenital skin provides an ideal environment for infection, particularly in the setting of risk factors such as use of antibiotics, vigorous sexual activity, diabetes, incontinence, immunosuppression, and obesity.

Women and infants who are estrogen deficient rarely experience vaginal yeast infections, although the anogenital skin can certainly exhibit C. Often, patients with chronic symptoms of vulvodynia are misdiagnosed with vulvovaginal candidiasis, but vulvodynia should produce symptoms of irritation, rawness, or burning rather than itching. These patients can generally be managed with fluconazole 150 mg weekly (49), although a very rare patient requires every fourth day dosing. In addition, there is no evidence that vulvovaginal candidiasis produces systemic symptoms of depression, bloating, constipation, headaches, etc (Table 15).
Those who fail this are usually given either boric acid vaginal capsules 600 mg once or twice a day for two to four weeks or flucytosine cream (47).
Boric acid, nystatin, flucytosine, gentian violet, amphotericin How To Deal With Rosacea and EczemaRosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Nystatin vaginal tablets or ointment twice a day for two to four weeks is a time-honored and soothing treatment that occasionally is useful in nonalbicans Candida infections resistant to azoles. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. Although vaginal secretions are generally reported as a dry "cottage cheese'' consistency, vaginal secretions are often normal clinically. Hepatotoxicity is not a major concern with weekly dosing, but some clinicians obtain liver function tests several times a year.
Otherwise, nonalbicans Candida infection shows only budding yeast, which can be more difficult to visualize microscopically.

Very often, the infection does not clear, but symptoms can be controlled with less frequent dosing. Some women benefit from oral or topical therapy as a preventive at times of high-risk such as during antibiotic therapy, vigorous sexual activity, or before menses.
Food and Drug Administration (FDA), and trials have shown itraconazole 200 mg a day for three days to be beneficial as well (45). In addition, recalcitrant yeast infections should be reevaluated by culture as false-positive microscopic examinations because of artifacts are common and patients are sometimes labeled incorrectly as having resistant or recalcitrant yeast infections. Patients with marked vulvar involvement may require more vigorous treatment, and those with substantial inflammation and fissuring sometimes experience burning with application of these creams. These patients often require several days of an oral azole or the application of soothing nystatin ointment in addition to standard treatments for vaginal candidiasis. All ''resistant'' yeast infections in immunocompetent women have been either nonalbicans Candida infection or a different underlying diagnosis altogether.

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