bubble_chart Overview

Fungal vaginitis (monilial or mycotic vaginitis) is caused by fungal infection. Its incidence rate is second only to trichomonal vaginitis. Candida vaginitis is commonly seen in young girls, pregnant women, diabetic patients, and postmenopausal patients who have received high-dose estrogen therapy.

bubble_chart Etiology

There are many types of fungi, with Candida albicans being the most predominant in the human body. Vaginal infections are caused by Candida albicans in 80–90% of cases, while the remainder are due to other species of Candida and Torulopsis. Therefore, fungal vaginitis is essentially candidal vaginitis or vaginal candidiasis. Candida albicans appears oval-shaped, forming pseudohyphae through budding spores and cellular sprouting elongation, with the pseudohyphae connecting to spores to create branched or chain-like structures. Candida is typically a saprophytic fungus that can inhabit the skin, mucous membranes, digestive tract, or other organs of healthy individuals, often residing in the vagina without symptoms. Among non-pregnant women with increased vaginal discharge, about 10% harbor this fungus, while approximately 30% of pregnant women have it in their vagina. When vaginal glycogen increases and acidity rises, or when the body's resistance weakens, it can become pathogenic. Prolonged use of broad-spectrum antibiotics and adrenal corticosteroids can significantly increase fungal infections, as these drugs disrupt the balance of microbial flora in the body, altering the mutual inhibitory relationships among vaginal microorganisms and reducing infection resistance. Additionally, vitamin deficiencies (particularly B-complex vitamins), severe infectious diseases, and other debilitating conditions can create favorable conditions for the proliferation of Candida albicans. During pregnancy, the glycogen content in vaginal epithelial cells increases, vaginal acidity rises, and the renal glucose threshold decreases, often leading to nutritional glycosuria. Elevated sugar levels in urine further promote the growth and reproduction of Candida albicans.

bubble_chart Clinical Manifestations

The most common symptoms of Candida infection are increased leucorrhea, burning sensation in the vulva and vagina, cutaneous pruritus, dysuria caused by external factors, and geographic erythema of the vulva (mycotic or Candida vulvovaginitis). Typical leucorrhea appears curd-like or patchy, with the vaginal mucosa showing severe redness and swelling. White thrush-like patches may be visible, easily removable, revealing an eroded base of damaged mucosa or forming shallow ulcers. In severe cases, ecchymosis may remain. However, not all leucorrhea exhibits these typical characteristics; it can range from watery to curd-like. Some cases may present entirely as thin, clear serous exudate, often containing white flakes. During pregnancy, the cutaneous pruritus symptoms of mycotic vaginitis are particularly severe, causing extreme discomfort and restlessness. Symptoms such as frequent urination, dysuria, and dyspareunia may also occur. Additionally, about 10% of women and 30% of pregnant women may be asymptomatic carriers of the fungus, showing no clinical manifestations.

bubble_chart Diagnosis

Based on typical clinical manifestations and visual inspection of vaginal discharge, diagnosing fungal vaginitis is usually not difficult. However, for atypical cases, to confirm the diagnosis, vaginal secretion examination is necessary for those suspected of carrying fungi or to evaluate treatment effectiveness. A small amount of vaginal secretion can be directly placed on a slide, mixed with a drop of isotonic sodium chloride solution or 10-20% potassium hydroxide solution, covered with a coverslip, and slightly heated for microscopic examination. Red and white blood cells and epithelial cells dissolve immediately, while fungi appear as thread-like fibers or mycelia, with micro-buds or conidia attached. However, this method has relatively low reliability (60%). If a smear of vaginal secretion is stained with Gram's method, clusters of Gram-positive, densely stained oval spores can be observed under the microscope, or pseudohyphae and budding cells connected in chains or branches can be seen, making identification easier and increasing reliability to 80%. The most reliable method is fungal culture. Additionally, attention should be paid to related predisposing factors, such as a history of high-dose steroid or broad-spectrum antibiotic use, and diabetic patients should undergo urine and blood glucose tests.

bubble_chart Treatment Measures

1. Alter the pH of the vagina, such as by using alkaline medications to rinse the vagina. A 2-4% sodium bicarbonate solution can be used to rinse the vagina to change the living environment of the fungi.

2. Administer fungicides:

(1) Nystatin vaginal suppositories (containing 250,000 U of nystatin) inserted deep into the vagina, once in the morning and evening or once nightly for 2 weeks.

(2) Oral nystatin 500,000 U, four times daily.

(3) Apply compound formula nystatin cold cream locally, twice daily.

(4) Oral ketoconazole 400 mg, twice daily for 5 days.

(5) Trichomycin (for details, refer to the treatment of trichomonal vaginitis). Additionally, oral clotrimazole or miconazole 0.5–1 g, three times daily, or topical application of 1–5% ointment or lotion, 3–4 times daily, is also highly effective.

(6) Topical application of 1–2% Chinese Gentian violet solution is a long-standing therapy that is also highly effective and widely used, though it has the drawback of staining underwear.

Pregnant women with fungal vaginitis may recover spontaneously after childbirth, but there is a risk of infection for the newborn. Therefore, timely treatment is still necessary, preferably with local medication, as described above.

3. Male carriers must also undergo routine treatment, as this is one of the key measures to prevent recurrence in female patients.

bubble_chart Prevention

1. Eliminate predisposing factors. For example, actively treat diabetes and promptly discontinue broad-spectrum antibiotics or estrogen.

2. Maintain good hygiene, change underwear frequently especially underpants. Wash and disinfect changed clothes thoroughly to avoid cross-infection in public places.

3. Vaginal fungal infections often coexist or interact with fungal infections in other areas, such as the mouth and intestines. If necessary, collect samples from these areas for fungal microscopy or culture. Patients with typical clinical manifestations and/or positive fungal tests should receive timely treatment.

4. For patients with stubborn or recurrent fungal vaginitis, sexual transmission is also one of the causes of recurrence. At least 10% of male partners of symptomatic women have fungal urethritis, so both should receive appropriate treatment simultaneously to prevent cross-infection.