Simple vulvovaginal candidiasis
Introduction
Introduction to simple vulvovaginal candidiasis Simple vulvovaginal candidiasis refers to vulvovaginitis caused by Candida infecting women. It mainly manifests genital itching, burning pain, severe restlessness, urgency, frequent urination, etc. The general symptoms are mild or moderate, and the annual incidence rate is < 4 times, more common in women, children can also be ill, is a common inflammatory disease of female reproductive tract infections. Yeasts colonized in the vagina are Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida rosenbergii, Candida cerevisiae, Candida krusei Candida, Candida albicans, etc., cause Candida albicans, mainly 80% to 90%, has identified more than 200 Candida albicans, all strains seem to have The same ability to colonize or cause vaginitis. With the changes of the times, the resistance of Candida increased, the strain changed, the proportion of Candida albicans in vulvovaginitis decreased, and the increase of vulvovaginitis caused by other Candida species Therefore, the formerly known as Candida albicans vulvovaginitis in obstetrics and gynecology seems to be too absolute and affirmative, currently known as Candida vulvovaginitis, but the strain is still mainly Candida albicans. basic knowledge The proportion of women: the incidence rate of women is about 30-60%, most women will suffer from this disease in their lifetime. Susceptible people: good for women Mode of transmission: sexual transmission Complications: Condyloma acuminata
Cause
Causes of simple vulvovaginal candidiasis
(1) Causes of the disease
In Candida, 80% to 90% of the pathogens are Candida albicans, 10% to 20% are Candida glabrata, Candida parapsilosis, Candida tropicalis, etc. The growth of yeast, the vaginal pH of Candida infection is more than 4.0 ~ 4.7, usually < 4.5, Candida albicans is a biphasic bacteria, yeast phase and mycelial phase, yeast phase is blast spores, It plays a role in asymptomatic colonization and transmission. The mycelial phase is blastospores elongated into pseudohyphae, and the ability to invade tissues is strengthened. Candida is not resistant to heat. When heated to 60 °C for 1 h, it is dead, but Dry, skylight, UV and chemical agents are more resistant.
Candida albicans is a conditional pathogen, 10% to 20% of non-pregnant women and 30% of pregnant women have this parasite in the vagina, but the amount of bacteria is very small, showing yeast phase, does not cause symptoms, only in the whole body and vagina The local immunity is reduced, especially the local cellular immunity is reduced. Candida bacteria multiply and transform into mycelial phase, which causes vaginal symptoms.
1. Many factors that are susceptible to infection of Candida in the range of obstetrics and gynecology
(1) Anatomical features of female genitalia: Female internal and external genital organs are connected, close to the outside world, and easily contact with pathogens. The self-defense mechanism of female reproductive tract is easily destroyed by many factors.
(2) Female endocrine changes Estrogen and progesterone secreted by the ovaries can affect the pH of the vagina, which can affect the colonization, germination, transformation of proteases and colonies of Candida.
(3) Candida, especially Candida albicans is a kind of bud yeast, widely distributed in the soil, hospital environment, and can be polluted by dust, food, normal people with the highest oral mouth, about 80%, Followed by about 50% of the intestine, 20% to 30% of the vagina, 2% of the skin, and 1% to 4% of the pharynx. When the symbiotic balance between Candida and the body is destroyed, it can be locally grown and multiplied. Skin, mucous membranes and even systemic candidiasis, combined with female genital anatomical features, approaching the anus, and because of the high rate of candida in the intestines of normal people, women are also prone to disease.
(4) The internal and external genital flora of women is complicated. There are dozens of microorganisms in the vagina of healthy women, which affects the normal vaginal flora. Lactobacillus exerts self-purification in the vagina, changes the pH value of the vagina, easily causes dysbacteriosis, and makes lactobacilli and other The detection rate of Gram-positive bacteria and anaerobic bacteria decreased, while the detection rate of Candida albicans was significantly increased, resulting in dysbacteriosis and easy onset.
(5) Female-specific pregnancy, childbirth, sexual intercourse, decreased immune function, etc.
(6) Effects of clothing and feminine hygiene products.
(7) The widespread use and even abuse of antibiotics has significantly increased the infection of Candida vulvovaginitis.
(8) maternal infection is easy to cause neonatal contamination of the birth canal during childbirth, causing neonatal thrush, diaper rash (red buttocks), eye, ear, head, armpits and other wrinkles or other skin parts of the infection, if it is premature Low-weight children, small samples, etc., because their immune function is not perfect, and therefore the baby is usually in the incubator after delivery, and often through various pipeline treatments, temperature, humidity and pipe retention for a long time are These babies are susceptible to Candida infections.
In summary, Candida infection in obstetrics and gynecology is a common and not negligible disease.
Predisposing factors
There are many predisposing factors for Candida vulvovaginitis, including the factors that promote the virulence enhancement of Candida and the related factors that reduce the local defense mechanism.
(1) Candida virulence enhancement factors: including pregnancy, diabetes, exogenous hormones (estrogen, corticosteroids), tight-fitting underwear, partial sweets, colony conversion.
1 Pregnancy: Changes in hormones in the body after pregnancy, especially after the formation of the placenta, the higher levels of estrogen, resulting in a high-glucose vaginal environment, providing a good and sufficient source of carbon for the growth and reproduction of Candida. It has been confirmed that there is an estrogen receptor that can bind to estrogen in the cytosol of Candida. Estrogen has the ability to promote the formation of pseudohyphae of Candida, so that the virulence of Candida is enhanced, clinically After the formation of placenta in the third month of pregnancy, the highest level of estrogen in the third trimester of pregnancy is more common, and the symptoms are severe, and the clinical treatment effect is much lower than that of non-pregnant women.
2 Oral contraceptives: After the use of oral contraceptives with high estrogen content, the colonization rate of Candida in the vagina is increased, and the mechanism is also the same as that during pregnancy. Clinically, it is also found that taking low estrogen levels The oral contraceptives hardly cause an increase in Candida vaginitis.
3 Diabetes: It is very common for pregnant women with Candida in the vagina to live in the vagina. The risk of vaginal vulvitis in patients with diabetes is increased. The recurrent Candida vaginitis in diabetic patients may be vaginal secretions. The sugar content is also high, which directly induces the growth of Candida. Clinically, patients with refractory Candida vaginitis must undergo a glucose tolerance test. It is generally considered that the simple dietary restriction on diabetic patients does not control Candida vaginalis. inflammation.
4 corticosteroids: Adrenal cortex hormones are used for a long time or a large amount, which is easy to cause the body's immune function to decline, causing the flora imbalance, so that Candida is easy to grow and breed and cause disease.
5 tights: often wear tights, especially hygroscopic and poorly ventilated synthetic, nylon pants or long-wearing tight denim pants, often lead to vulva and vaginal local tissue moisture and temperature rise, mucosal impregnation, friction damage May change the internal environment of the vagina and induce vulvovaginal inflammation. There were comparisons between plain asymptomatic pants and loosely hygroscopic clothes for women with asymptomatic normality. After 2 months, the positive rate of Candida in the vagina was found. Higher than the latter (Beed BD, 1992).
6Women's Hygiene Products: Commercial irrigators used in women's health, scented toilet paper, women's sanitary sterilizers, menstrual paper mats, etc., contribute to the occurrence of Candida vulvovaginitis, which is caused by cross infection or disinfection. Severe or itself has Candida infection, etc., can also change the vaginal environment and promote asymptomatic immigration, into the occurrence of symptomatic vulvovaginitis.
7 Swimming in an unchlorinated pond or swimming in a chlorinated swimming pool, but the health check of the swimming pool is not strict, or the sputum of the public toilet is often impregnated with Candida, causing cross-infection.
8 In addition, there are overnutrition, malnutrition, implanted catheters, malignant tumors, alcoholism, drug abuse, and abdominal surgery are also risk factors for Candida albicans infection.
9 partial sweets and dairy products, edible moldy fruits, etc., preference for sweets refers to the love of more than ordinary people's sweets, resulting in increased blood sugar and vaginal cells and secretions, which is conducive to the growth and reproduction of Candida, dairy products In the case of itself, it is easy to increase the number of Candida, the number of Candida in the moldy fruit is also increased, and it is easy to get into the intestines in the contaminated vulva.
(2) Factors related to reducing the local defense mechanism:
1 Antibiotics: Candida vulvovaginal vulvitis often occurs during long-term use of antibiotics or after treatment. No matter whether oral or parenteral or topical antibiotics are used, although any antibiotic drug may cause the disease, The most common antibiotics such as tetracycline (which has been eliminated in China and still used abroad), ampicillin and cephalosporin antibiotics are all prone to aggravate symptoms or cause morbidity, because the use of antibiotics mainly kills vaginal pathogens and also causes the vagina. The dysbacteriosis within the flora reduces the normal flora and weakens the ability of the normal flora to inhibit yeast. In the micro-ecological environment of the vagina, when the lactobacilli is reduced, the yeast will multiply and germinate in the vagina. The occupancy rate increased from 10% to 30%. Similarly, antibiotics can directly induce the growth and reproduction of Candida.
Antibiotics not only make the flora in the vagina dysregulated, but also reduce the normal flora in the intestine, so that the yeast in the intestine grows and multiplies.
2 Sexual life: Candidiasis vulvovaginitis patients should suspend sexual life before they are cured. If during sex life, the man should also use condoms, because sexual life has different opinions on the spread of Candida vaginitis. However, the following matters should be brought to the attention and attention:
A. Male glans, foreskin and coronary sulcus, and scrotum wrinkles are infected with Candida, which can cause Candida balanitis (even glans rupture), scrotal inflammation, dermatitis, etc., without protective measures Sexual life is easily transmitted to the woman because 15% to 18% of male genital candida cultures are positive, and balanitis is caused by spouses suffering from vaginal infection of Candida or asymptomatic fungal vagina.
B. The above part of the male has a Candida infection, and the oral infection of the female oral Candida infection is also increased.
C. When the woman has a Candida infection in the vagina, she does not use protective measures to live sex, causing male Penileus infection, common penile rash, erythema, itching and burning sensation, in the absence of protective properties. A few minutes or hours after the birth, if the shower is taken after sex, the symptoms can be relieved or subsided.
D. Male genital candida positive female partner, the positive rate of Candida vaginalis is higher than that of male genital negative female partner, male partner of vaginal candida positive female, genital candida bacteria The rate is 4 times higher than that of male counterparts in negative women.
E. Other parts of the male body, such as the rectum, mouth, semen and urine may also have parasitic bacterium of Candida, clinically giving the male anti-candida drug treatment, but also reducing the female vaginal vaginal Repeated attacks of inflammation.
F. Semen can induce Candida to form a virulence hyphae, thereby invading the vaginal mucosa, causing the occurrence and recurrence of Candida vulvovaginitis.
G. Sexual intercourse with more sexual partners, frequent sexual life, sexual health, etc., such women have a high incidence of Candida vulvovaginitis, and many relapses, detected by commercial sex workers (prostitutes) The high rate is an obvious example.
H. Candida vulvovaginitis itself is also one of the types of sexually transmitted diseases, the definition of sexually transmitted diseases also indicates that the disease can be transmitted through sexually transmitted diseases.
In summary, the pathogen has been included in sexually transmitted diseases, so it is easy to explain whether the objection to the disease is sexually transmitted.
Actual sexual intercourse and Candida infection have been well known. For example, the frequency of vulvovaginitis is also high in those with high frequency of sexual intercourse, especially higher than those without sexual intercourse. Domestic reports of 236 on Candida balanitis and In the investigation of Candida vulvovaginitis, 30.5% of people with extramarital sex and 38.6% of couples have sex infections. It is also reported that about 20% of males in this class are positive for yeast and have the same DNA type, but most reported in the treatment of recurrent vulvovaginitis, although its sexual partners at the same time still does not work.
3 AIDS: AIDS is also a sexually transmitted disease. These patients have low immune function and are susceptible to Candida infection. In the study of Candida resistance in different regions of different countries, it was found that Candida strains isolated from AIDS patients 10 % is resistant to fluconazole. More than 33% of Candida albicans in AIDS patients are resistant strains, and vaginal local defense mechanisms are reduced.
In addition to the above-mentioned Candida virulence enhancement factors, factors related to reducing the local defense mechanism, there should be immune-related factors:
In patients with endometriosis, the incidence of Candida vaginalis is higher than that of the normal population, in addition to the relatively high levels of estrogen in the body with endometriosis, and also with Candida albicans Infections and endometriosis patients have similarities in immune changes. Candida albicans infection activates macrophages, causing interleukin-1 (IL-1), interleukin-6 (IL-6) Tumor necrosis factor alpha (TNF-) and prostaglandin E2 are elevated, and complement C3-mediated phagocytosis is inhibited. These phenomena suggest that there is a relationship between Candida infection and the onset of endometriosis. There is a cross-reaction between Candida albicans antibodies and certain helper T cells and ovarian cells. Anti-ovarian antibodies also play a role in the relationship between Candida and female autoimmune diseases. Therefore, some scholars It is hypothesized that Candida albicans infection may be a trigger for autoimmune changes in endometriosis.
Endometriosis and Candida albicans are also associated with allergies and are susceptible to allergic reactions to allergens, all of which have IgE-mediated delayed type hypersensitivity.
(two) pathogenesis
Under normal circumstances, Candida albicans is in a symbiotic state with the body, and does not cause disease. When certain factors destroy this equilibrium state, Candida albicans is transformed from yeast phase to hyphae phase, which grows and multiplies locally, causing skin. , mucosa and even systemic candidiasis.
Impaired normal defense function of the body leads to endogenous infections, such as trauma, antibiotic application and cytotoxic drug use, dysbacteriosis or mucosal barrier function, corticosteroid application, malnutrition, immune function defects.
Candida is a biphasic bacteria, which is normally a yeast phase. It turns into a mycelial phase when it is diseased. Therefore, pseudohyphae is found to be an important evidence for Candida infection in cell smears or tissue sections.
The virulence factors of the pathogenic mechanism of Candida vulvovaginitis include: attachment, germination, protease, and colony transformation.
Attach
In order to colonize the vaginal mucosa, Candida is first attached to vaginal epithelial cells. Candida albicans is more likely to adhere to vaginal epithelial cells than Candida tropicalis, Candida krusei and Candida tropicalis. However, the extent to which vaginal cells receive Candida is quite different from person to person.
Similarly, the vaginal cells of women with stubborn Candida vulvovaginitis have not shown an increase in the affinity for Candida. All Candida albicans seem to have the ability to colonize the mucosal surface, so the vaginal mucosa certainly It is the place where Candida is easy to colonize. The adhesion of yeast is due to the mannose glycoprotein on the surface of the yeast. It is accomplished by binding to the receptor of the glycoprotein of the host cell. In addition, hydrophobic force and static electricity Gravity also promotes adhesion, and adhesion (or adhesion) is an important part of Candida mucosal colonization and invasion of the body. Candida bacteria without adhesion are not pathogenic.
2. Formation of germ tube and hyphae
After Candida adhesion to vaginal mucosal epithelial cells, the formation of budding or pseudohyphal formation, the formation of hyphae is a way to obtain nutrients effectively, and the formation of the same tube increases the attachment of Candida albicans The ability of the vaginal or oral epithelium to exfoliate cells, the formation of germ tubes and mycelium, contributes to the invasion of the vaginal mucosa epithelium.
The key role of Candida germination after attachment is the basis of many studies and investigations of acute, especially recurrent Candida vaginitis. If the endogenous or exogenous factors of germination are increased or promoted, it may tend to cause Symptoms of vaginitis, on the contrary, if the inhibition of Candida adhesion after germination, it can prevent the occurrence of acute Candida vaginitis in asymptomatic carriers, hyphae can grow along the gap of the skin mucosa, by mechanical force Reproduction through the epidermis or epithelial cell surface, hyphae is an important component of Candida virulence in skin mucosal infections and in disseminated infections.
3. Secreted protease
Candida albicans can secrete a variety of proteolytic enzymes, such as alkaline phosphatase, phospholipase and secreted asparaginase, etc., the above various hydrolases can help the long tube to penetrate into intact mucosal epithelial cells, acute false Patients with vaginal vaginitis have a stronger proteinolytic effect than asymptomatic carriers.
4. Colony conversion
The same strain of Candida albicans can form several colony forms under certain conditions, which is a high frequency heritable phenotypic variation, white colonies are converted into opaque colonies, cells in opaque colonies and cells in the original white colonies are not only Different in phenotype, and increased resistance to fungal drugs, with new virulence, including adhesion, germination, production of proteases and the ability to form mycelia, opaque cells seem to be a special Invading the temporary state of the tissue, colony conversion increases the virulence of Candida by supplying the ability to invade different parts of the body and altering the antigenicity.
In addition to the above-mentioned attachment, germination, protease and colony conversion, the pathogenesis of Candida vulvovaginitis also has an inflammatory reaction. The bacterial component of Candida can activate the complement alternative pathway, producing complement chemokines and allergies. Toxins, causing local vasodilation, increased permeability, local edema and inflammatory cell infiltration, phagocytic cells locally aggregate, and phagocytose bacteria, while releasing lysosomal enzymes, causing local tissue damage.
Candida can live in the vagina of healthy asymptomatic women, with a wide range of residence rates ranging from 10% to 55%. In young, non-pregnant, premenopausal women, the survival rate is 15% to 25%. Observed asymptomatic colonization and culture for several months, can be found in positive women, juvenile and postmenopausal women have some resistance to the colonization of Candida, suggesting that the vaginal environment is significantly different, also Prompt infection and hormone dependence, especially related to estrogen, when the initial colonization of Candida, the number is still relatively small, mainly in the yeast phase, when the disease turns into a mycelial phase, from asymptomatic carriers The difference between Candida isolated from women with significant vaginitis.
There are many factors that contribute to the colonization of Candida in the vagina. It is related to or promotes the occurrence of vaginitis of Candida. Different factors can promote the germination and germination of yeast by changing the micro-ecological environment of the vagina. The colony is converted into vaginitis.
The key issue of the pathogenesis of Candida vaginitis is how asymptomatic vaginal colonization turns into symptomatic Candida vulvovaginitis. In the asymptomatic carrier state, Candida is mainly non-hyphal. The number of bacteria is relatively small. In this case, there is a delicate balance between the presence of the hyphae of the candida and the protective colony, and the local defense mechanism. When there is a factor that enhances the toxicity of Candida or Symptomatic vaginitis occurs when the local defense mechanism is weakened.
Prevention
Simple vulvovaginal candidiasis prevention
1. Prevention of vulvovaginal candidiasis
(1) For the first occurrence of Candida infection, it should be thoroughly treated: Candida albicans can grow on the surface of the mucous membrane or invade the deep layer. If the infection is insufficient, the time is too short, it is not easy to completely kill the sterile silk. And spores, and easy to produce drug resistance, resulting in recurrent Candida vulvovaginitis, so for the first patient, thorough treatment is very important, you can take local treatment or combined systemic treatment, and can use consolidation treatment, that is, initial treatment The treatment was repeated 10 days later.
The standard of thorough treatment for the first time was that the symptoms disappeared after the initial treatment, the signs returned to normal, the negative detection of Candida, and three consecutive menstrual examinations, the above were negative.
(2) Check for systemic diseases, timely detection and treatment: The most suitable pH environment for Candida albicans growth in the vagina is 4 to 5. When various factors increase the amount of glycogen in the vagina, the acidity is most suitable. Candida reproduction causes inflammation, blood sugar levels increase during diabetes, and the local glycogen content of the vagina increases, thereby changing the normal pH value in the vagina, forming an internal environment conducive to the growth of Candida, causing infection, on the other hand Diabetic patients have multiple defects in white blood cell function, and are easy to be combined with bacterial infection. The application of antibiotics is also easy to induce Candida vaginitis. Therefore, blood sugar should be checked. For diabetic patients, blood glucose monitoring should be strengthened to control blood glucose between 6.11 and 7.77. Mmmol / L, if the patient can not achieve the ideal blood sugar after diet treatment, the application of drugs to treat diabetes, systemic treatment to restore the local environment of the vagina to normal, is not conducive to the growth and reproduction of Candida.
(3) Improve the local environment of vaginal: The optimum temperature for the growth of pathogenic Candida albicans is 37 ° C. The increase of local environmental temperature is more conducive to the growth of Candida. In addition to the low systemic immune function, the local pH of the vagina Changes, humidity, and increased temperature are more likely to be secondary to Candida infections.
(4) Improve immunity: Candida vulvovaginitis is both a localized disease and a systemic disease, which means that Candida is a conditional pathogen, that is, in host resistance. When the immunity is low, the host is pathogenic. The gamma interferon can inhibit the production of PGE2 by macrophages, thereby inhibiting the formation of spores, germination and growth of the fungus. Therefore, for some diseases, the immunity of the body is low, such as long-term use of immunosuppressants. Etc., gamma interferon can be used to prevent Candida albicans inflammation, the immune function of the body during menstruation will also change, prone to Candida infection, so should pay more attention to rest.
(5) Strict control of antibiotic application: Candida albicans is one of the normal flora of the human body. About 10% of women have parasitic bacteria in the vagina without obvious symptoms. The application of antibiotics will affect the flora in the vagina and intestine. Disorders, especially the current abuse of antibiotics, are quite common, which makes the imbalance of microbial relationships, and it is easy for Candida to multiply and cause disease. The longer the antibiotics are used, the more chances of infection with Candida. People who use antibiotics have a 2-fold higher infection rate than Candida's vulvovaginitis. When using broad-spectrum antibiotics for 10 to 14 days, the chance of developing Candida vulvovaginitis is increased by 3 times. There was no significant relationship between the species and Candida infection (Spini-llo A, 1999). Patients with continuous antibiotics for 10 days had 20% of Candida vulvovaginitis, while those who took antibiotics once had no falsehood. Strain yeast infection.
The use of antibiotics is a short-term risk factor for Candida vaginal vulvovaginitis. Long-term use is the direct cause of the increase in the prevalence of Candida vulvovaginitis. Therefore, when there is infection in each system, the adaptation of antibiotics should be strictly controlled. Proof, especially the application of broad-spectrum antibiotics, pay more attention to timely withdrawal, if necessary, oral antifungal drugs to prevent secondary candidiasis vulvovaginitis.
(6) Advocating the simultaneous treatment of sick women and their partners: Candida vulvovaginitis is a sexually transmitted disease. The sexual partners of Candida vulvovaginitis have their oral cavity, semen and penis in the coronal sulcus. A certain proportion of Candida positive rate, clinically treated with sexual partners, the recurrence rate is significantly lower than the sexual partner treatment group, the treatment group recurrence rate is also low (treatment group recurrence rate of 15.8%, untreated group recurrence The rate is 44.8%), especially for those who have oral sex, it is necessary to carry out the cultivation of Candida and the identification of strains of the patient's sexual partners semen and oral secretions. The treatment of the woman alone is easy for the man to cross infection, and the condom can be reduced. Cross infection between sexual partners.
(7) Application of biological agents and dairy products containing acidophilic lactic acid bacteria: Biological agents with therapeutic properties such as acidophilic lactic acid bacteria can not only prevent infantile diarrhea, antibiotic diarrhea, but also prevent candida vulvovaginitis and intestines. Infection, no obvious side effects, thus reducing the dependence on antifungal drugs, therefore, the biologic preparation can be tried for patients susceptible to Candida, and the effect may be to restore the normal proportion of the flora.
Ingestion of dairy products containing acidophilic lactic acid bacteria for 6 consecutive months, the incidence of intestinal and vaginal candida infections is 3 times lower than that of uneaten, and the number of colonies of candida and vaginal candida in the group is also Significantly lower than the uneaten group, daily intake of a certain amount of lactic acid products can reduce the formation of Candida colonies and reduce infection (Hilton E, 1992).
In short, the occurrence of Candida vulvovaginitis is a multi-factor, prevention should also be individualized, take appropriate measures for their respective links, thereby reducing recurrence or preventing infection.
2. Gynecological and family planning Candida infection problems
There are many operations through the vagina into the uterine cavity, including gynecology and family planning work. Commonly used surgery has various intravaginal minor operations, such as physical therapy for cervical erosion commonly used in gynecology - laser, electrocautery, freezing, microwave, Infrared, ohmic wave, etc., cervical dilatation, uterine cavity measurement, various curettage - diagnostic curettage, segmental diagnosis, uterine submucosal myomectomy, hysteroscopy, hysterosalping iodine angiography, endometrium Electrical cutting, endometrial ablation and other intrauterine operations; artificial abortion involved in family planning work, curettage after medical abortion, placement and removal of intrauterine devices, intrauterine device exploration, and assisted reproductive technology Artificial insemination, intrauterine transplantation, through the vaginal posterior fornix into the abdominal cavity for ovarian puncture to take eggs, reduction of fetal surgery, or gynecological diseases of the posterior vaginal puncture, etc., as well as gynecological commonly used hysterectomy, extensive resection, etc., if Candida infection in the vagina will affect the operation as scheduled, and surgery after treatment, often due to missed surgery time and affect the timely treatment.
Gynecological vaginal minor surgery is usually performed within 3 to 7 days after menstruation, which is also the follicular phase of the menstrual cycle. If the operation is followed, it may be affected by ovulation factors and sexual life, and may affect the operation, and the second half of the menstrual cycle. When the pelvic cavity is also more congested, the operation is easy to cause bleeding, etc. Cervical physiotherapy, because the wound is not healed after the next menstruation, easy to cause endometrium in the menstrual blood to be implanted on the cervix and cause cervical endometriosis, Therefore, these unique gynecological features, if 3 to 7 days after the operation and preoperative vaginal vaginal discharge test for Candida infection, need to stop the operation, after treatment, the leucorrhea secretion is negative after 3 to 7 days after the next menstrual period. Can only be operated after surgery, so Candida infection can affect surgery or increase patient suffering, such as the original plan for electro-absorption abortion, due to Candida infection, increase gestational age, beyond the scope of electro-absorption abortion Induction of labor in the mid-term pregnancy; the original IUD can be placed or removed, due to treatment of vaginal candida infection, etc. will be postponed until the next month, so delay and delay surgery Or causing an increase in the level of surgery, often causing inconvenience or increasing the pain of surgery, so in order to reduce postoperative complications, strict surgical indications, routine vaginal secretion before gynecological surgery, family planning surgery and assisted reproductive surgery operations The substance is tested for the presence or absence of Candida and/or mixed infection, and rapid and effective antifungal treatment is adopted, and then timely surgery is preferred.
In the case of family planning, the infection of Candida vaginalis was found before surgery. The Pediatric Hospital of Peking Union Medical College Hospital and Xuanwu Hospital conducted a multi-center comparative study using Kanetin (500mg clotrimazole lactic acid formula) and clotrimazole. 3 tablets of 150mg, after the drug were followed up on the 4th day, ask the main complaint, carry out gynecological examination and vaginal secretions to check Candida. If the test of Candida is negative, you can make an appointment for surgery. If the positive person repeats or continues treatment, another On the 14th day after surgery, the results showed that the curettage accounted for 58.33% on the 4th day, the effective effect accounted for 31.67%, the total effective rate was 90%, and the clotrimazole group cured rate was 40%, the marked efficiency was 26.67%, and the total effective rate was 66.67%, the treatment effect of the two groups was statistically significant (P<0.01). The total effective rate was 92.98% in the Kenitin group and 79.59% in the clotrimazole group. The above results suggest that the drug is used. On the fourth day, Kenitin can make 90% of patients with Candida vulvovaginitis to operate in time, and the clotrimazole group is only 55.56%. Therefore, Kenitin shortens the course of treatment for most patients, so that vaginal surgery can be carried out in time. Single-dose Carnitine in the treatment of false silk The vulvovaginal vaginitis can maintain an effective antifungal concentration in the vagina for at least 3 days and increase the tissue permeability of the vaginal vaginal tablets. Lactic acid and clotrimazole have a synergistic effect, and lactic acid makes the vaginal pH acidify, which can significantly increase the gram The local bioavailability of azole, while the lactic acid formula helps restore and maintain the normal physiological environment of the vagina (Mend-ling, W, 1995), thus allowing a single dose of carbidine and the control group of clotrimazole to be administered multiple times before vaginal surgery Compared with the effect of Candida vaginitis, it has a good clinical effect. It not only shortens the course of treatment, accelerates the progress of surgery, but also has a long-lasting effect on drugs and a low recurrence rate. It is a gynecology, family planning and assisted reproductive surgery. The preferred drug for patients with Candida vaginal vulvitis, if the treatment with other drugs is longer, usually takes 7 days, or even 10 to 14 days. The long course of treatment often causes the patient to lose the timing of surgery or increase the level of surgery. Pain and so on.
Gynecological all kinds of uterus resection, all kinds of vaginal surgery, hysteroscopy and laparoscopy and surgery are also like the above, preoperative vaginal candida infection is not cured, easy to enter the pelvic cavity due to surgical operation, or affect postoperative vaginal disability End healing, laparoscopy or surgery, for married people must also pass through the vagina and cervix, built into the uterine cavity, if the preoperative vaginal candida is not treated, it is easy to cause uterine or pelvic infection, so it should be The same as before family planning, vaginal minor surgery or assisted reproductive technology, actively adopt fast and effective drugs to fight for early surgery.
Complication
Simple vulvovaginal candidiasis complications Complications Condyloma acuminata
When there is a Candida infection, it is easy to combine with other pathogens and complicated with other sexually transmitted diseases, such as AIDS, genital warts, gonorrhea and non-gonococcal vaginitis.
Symptom
Symptoms of simple vulvovaginal candidiasis common symptoms vulvar itching scaly vaginal discharge increased urinary frequency congestion urgency blister
Candida vaginal vulvitis is mainly characterized by genital itching, burning pain, severe restlessness, abnormal pain, often accompanied by frequent urination, urgency and dyspareunia.
In the acute phase, the leucorrhea increases. The leucorrhea is characterized by thick white curd or bean dregs. If there is vulvitis, the vulva can be clearly defined with erythema, and around the large erythema, small satellite lesions can be seen, sometimes visible in the genital area. Scratches or cleft palate skin, but also secretions are odorless and yellow-white. When the environment is warm, such as when the bed or air circulation is limited, or when the patient wears tights or synthetic fabric, the symptoms will be aggravated.
Vaginal mucosa can be seen with varying degrees of edema, erythema, erythema can continue to the outer cervix, vaginal secretions often stick to the vaginal wall, when the blocky secretions are erased to reveal red and swollen mucosal surface, visible in the acute phase There are damaged erosion surfaces and superficial ulcers under the white mass.
Sometimes there are small nodules and blisters on the edge of inflammation. If the surrounding large tissues are involved, it can be seen that the infected area is dry scaly, with clear edges (eczema-like changes), and scratches and ulcers often have scratches.
The severity of the symptoms depends on the genus and strain of the infected bacteria and the susceptibility of the patient. The mild symptoms may only be mild itching without other clinical symptoms. Candida vulvovaginitis is different from other infected bacteria, and yeast does not. It rises along the cervical canal and therefore does not cause secondary conditions associated with Candida migration.
Candida infections often occur in the late luteal phase of the ovulation cycle, which is within 1 week before menstruation.
The clinical features of Candida albicans vulvovaginitis during pregnancy are vaginal secretions. In almost all cases, there are severe genital itching, often accompanied by genital burning, and even vaginal pain and irritation. The typical secretion is Cheese liquid sample, labia minora with edema, erythema, vaginal congestion and often with a white membrane, peeling off the white membrane, can reveal red and swollen mucosal surface, in the acute phase can see erosion surface or superficial ulcer.
The symptoms and signs of Candida vaginitis in children are not different from those in adults, but leukoplakia or patterns are often seen.
Typical cases are not difficult to diagnose, and are easily diagnosed based on relevant medical history, predisposing factors, symptoms, signs, and laboratory diagnosis.
Examine
Examination of simple vulvovaginal candidiasis
1.60%
(1)12
(2)10% KOH10% KOH10%70%80%
2.80%
3.372428h100%10
4.
5.pHpH<4.5pH>4.5
6.
Diagnosis
Diagnostic criteria
pH<4.5pH>4.5pHpH()()pH(pH4)
Differential diagnosis
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2.
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