Vaginal yeast infection

Disease Description (Causes and Symptoms)

• Cause: Mainly caused by overgrowth of Candida in the vagina and vulva, primarily Candida albicans. Risk factors include a decrease in lactobacilli (use of broad-spectrum antibiotics), a high-estrogen state (pregnancy, hormone therapy), high blood glucose (diabetes), and immunosuppression (steroids, immunosuppressants, HIV).
• Pathophysiology: When the balance of the normal vaginal flora (Lactobacillus) is disrupted, Candida proliferates and adheres to the mucosal epithelium, causing inflammation and pruritus.
• Main symptoms: Severe vulvar itching (pruritus), redness and swelling of the vulva and vagina, viscous “cheese-like” discharge (white and curd-like), dyspareunia, and dysuria. Vaginal pH is often within the normal range (approximately 4–4.5).

Treatment Methods (Standard Treatment · Lifestyle Management · Precautions)

• Medication treatment
  • Topical antifungals: Vaginal tablets or creams such as clotrimazole and miconazole are used for 1–7 days (short-term 1–3-day or 7-day regimens). First-line choice during pregnancy.
  • Oral antifungals: A single 150 mg dose of fluconazole is commonly used (in nonpregnant women).
  • Management of recurrent disease (4 or more consecutive episodes/year): Suppressive therapy such as induction therapy (three doses of fluconazole 150 mg at 72-hour intervals) followed by maintenance therapy (fluconazole 150 mg weekly, usually for 6 months) is recommended.
  • Non-(or azole-)resistant/non-albicans strains: Alternative treatment such as intravaginal boric acid 600 mg vaginal suppositories for 14 days may be considered (use under a doctor’s guidance).
• Lifestyle management
  • Avoid wearing tight clothing or wet swimsuits for long periods, cotton underwear is recommended, avoid excessive use of cleansers and vaginal douching, and control blood glucose (if you have diabetes).
  • Sexual partners generally do not need treatment if they are asymptomatic (evaluation is needed if the partner has symptoms).
• Precautions and risk of complications
  • During pregnancy, avoid long-term use of high-dose oral fluconazole and prefer a topical azole.
  • In patients with recurrent disease, diabetes or immunosuppression, medication use (broad-spectrum antibiotics, steroids), and lifestyle factors should be reviewed.
  • Candidal vulvovaginitis is generally a localized infection, and serious complications (such as systemic infection) are rare. Delayed standard treatment may lead to chronic vulvitis or persistent discomfort (chronic itching). Depending on clinical data, rare associations with pregnancy-related problems or pelvic infection have also been reported, so additional evaluation is recommended if symptoms persist.

Checklist Before an Outpatient Visit (Including Items to Prepare · Example Questions)

• Items to prepare/checklist
  • A list of all medications currently being taken (including prescription drugs, OTC medications, and herbal products)
  • Whether antibiotics or steroids were recently used and when they were used
  • Possibility of pregnancy or whether you are pregnant (date of the last menstrual period)
  • History of diabetes or immunocompromising diseases, and recent blood glucose levels (if available)
  • When symptoms began and how they have progressed (the timing and severity of itching), and a photo of the discharge (if possible)
  • Previous treatments and their effects (e.g., whether symptoms improved after taking fluconazole, and the frequency of recurrence)
  • Results of recent tests for other sexually transmitted infections (if available)
• Basic items the clinician may ask about during the visit
  • When the symptoms first occurred and how they have progressed
  • Whether antibiotics were recently taken and for what purpose
  • Pregnancy status and contraceptive method
  • Whether the partner has symptoms

General Examples of Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (or treatment)?
• What treatment options are safe to use during pregnancy or breastfeeding?
• What lifestyle changes should I make to reduce recurrence?
• If this is recurrent, are additional tests (culture, antifungal susceptibility testing, blood glucose and immune testing) needed?
• If there is no improvement after taking the medication, when should I return for another consultation?

Examples of Disease-Specific Questions

• I am pregnant. What treatment options are safe? Can I take oral fluconazole?
• I have recurrences four or more times a year. How should a plan be established to identify the causes of recurrent candidal vulvovaginitis (e.g., diabetes, immune abnormalities, or drug resistance) and to provide suppressive therapy?

(Reference summary: This disease is a common vaginal and vulvar infection caused by Candida. When the symptoms and history are typical, it usually improves with simple medication treatment; in recurrent cases, additional testing and long-term suppressive therapy may be considered. Treatment selection and precautions vary depending on pregnancy, diabetes, and immunosuppression.)