Vaginitis: Monilial

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 95 Vaginitis: Monilial

INTRODUCTION

Description: Monilial vaginitis is a vaginal infection caused by ubiquitous fungi found in the air or as common inhabitants of the vagina, rectum, and mouth.
Prevalence: Twenty-five percent to 40% of “vaginal infections;” 75% of women experience one or more lifetime occurrences.
Predominant Age: 15 to 50 (rare outside this range except for those receiving estrogen replacement after menopause).
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Candida albicans (80% to 95%), Candida glabrata, Candida tropicalis, or others (5% to 20%).
Risk Factors: Altered vaginal ecosystem (stress, antibiotic use, pregnancy, diabetes, depressed immunity, topical contraceptives, and warm and moist environment).

CLINICAL CHARACTERISTICS

Signs and Symptoms (15% asymptomatic carrier rate)

• Vulvar itching or burning (intense)
• External dysuria, dyspareunia
• Tissue erythema, edema, and excoriations
• Thick, adherent, plaquelike discharge with a white to yellow color (generally odorless)
• Vulvar excoriations

DIAGNOSTIC APPROACH

Differential Diagnosis

• Bacterial vaginitis
• Bacterial vaginosis
• Trichomonas vaginal infection
• Contact vulvitis (allergic vulvitis)
• Atrophic vulvitis
• Vulvar dermatoses
• Pinworms

Associated Conditions: Diabetes, immunosuppression or compromise (as risk factors for infection), chronic vulvitis.

Workup and Evaluation

Laboratory: Culture (Nickerson’s or Sabouraud media) or monoclonal antibody staining may be obtained but are seldom necessary.
Imaging: No imaging indicated.
Special Tests: Vaginal pH 4 to 4.5.
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