1ST CITY CLINICAL HOSPITAL

Mycoses are a widespread group of infections caused by a large number (more than 200) species of various pathogenic and opportunistic fungi.

Causative agents of the disease: yeast-like fungi, most often Candida (Candida albicans). This type of fungus is found in 84–95% of cases of clinically pronounced genital candidiasis. Candida fungi are opportunistic pathogens; they are often saprophytes of the mucous membranes (mouth, intestines, vagina) and skin.

Candida fungi can be isolated from the vagina of practically healthy women in the absence of clinical signs of inflammation and other gynecological diseases.

Candidiasis infection is often associated with disturbances of the vaginal microcenosis. Depending on the state of the vaginal microcenosis, there are 3 forms of Candida infection of the vagina:

• asymptomatic candidiasis, in which there are no clinical manifestations of the disease, yeast-like fungi are detected in a low titer (less than 10 4 CFU/ml), and lactobacilli absolutely dominate among the microbial associates of the vaginal microcenosis;
• true candidiasis, in which fungi act as a monopathogen, causing a clinically pronounced picture of the disease. At the same time, Candida fungi are present in high titers in the vaginal microcenosis (more than 10 4 CFU/ml), in the absence of diagnostically significant titers of any other opportunistic microorganisms;
• a combination of vulvovaginal candidiasis and bacterial vaginosis, in which yeast-like fungi participate in polymicrobial associations as causative agents of the disease. In these cases, yeast-like fungi (usually in high titer) are found against the background of a massive amount (more than 10 9 CFU/ml) of obligate anaerobic bacteria and gardnerella with a sharp decrease in the concentration or absence of lactobacilli.

The disease can occur in acute and chronic forms. The acute form lasts no more than 2 months. This disease is characterized by relapses. Recurrent vulvovaginal candidiasis is a special variant of the course of the chronic form of the disease. Recurrence is defined as the reappearance of symptoms of the disease within 1 year (4 or more episodes.

The clinical picture of vulvovaginal candidiasis is characterized by the following symptoms:

• heavy or moderate curdled discharge from the genital tract;
• itching, burning, irritation in the external genital area;
• increased itching during sleep, after urination, water procedures and sexual intercourse;
• unpleasant sour smell.

Candidiasis is not a classic sexually transmitted disease. This is a pathology caused by decreased immunity.

The causes of persistent candidiasis may be:

• the presence of a chronic infection of the reproductive system or any other system of the body. The immune system is exhausted in the fight against chronic inflammation, and this is also manifested by candidiasis; sexually transmitted diseases;
• sexually transmitted diseases;
• chronic diseases of the kidneys, liver, intestines - colitis, dysbacteriosis;
• hormonal disorders: decreased thyroid function, diabetes, obesity;
• taking hormonal drugs: prednisolone, dexamethasone, metipred, etc.;
• taking antibiotics that cause immunodeficiency and intestinal dysbiosis;
• poor nutrition, in particular, excess sweets, can also lead to the development of dysbacteriosis and the proliferation of fungi;
• improper use of eubiotics.

The above shows that candidiasis is a marker of trouble in the body, and in addition to specific treatment with antifungal drugs, it requires a full examination and elimination of the root cause of immunodeficiency.

Therapy for genital candidiasis is carried out only in the presence of clinical signs of vulvovaginitis and when Candida is detected by microscopy or culture. Asymptomatic carriers do not require treatment.

Drugs for the treatment of candidiasis are divided into systemic and local. Systemic tablets are tablets taken orally, acting primarily in the intestines, and then absorbed into the blood and penetrating into all organs and tissues of the body. Outside of pregnancy, this type of medication is the main one and preferable to local ones (suppositories, creams), since the main focus of fungi is in the intestines, and that is where they need to be destroyed first.

Local treatment includes suppositories, vaginal tablets and creams. It can be combined with a systemic one, and is preferable during pregnancy.

Drugs for the treatment of vulvovaginal candidiasis are divided into the following groups:

• polyene drugs (nystatin, levorin, pimafucin, amphotericin B);
• imidazole drugs (clotrimazole, ketoconazole, miconazole, econazole);
• triazole drugs (fluconazole, itraconazole);
• azole drugs - drugs of 2 actions (sertaconazole);
• combination drugs (Polygynax, Klion D 100, Macmiror complex);
• other drugs (griseofulvin, nitrofungin).

It should be noted that chronic recurrent and persistent forms of vulvovaginal candidiasis are characterized by the resumption of symptoms soon after the end of the standard or double course of therapy. In these cases, it is recommended to administer an initial course of systemic therapy, followed by a course of prophylactic therapy to prevent relapse.

After curing vulvovaginal candidiasis, it is necessary to restore the vaginal microcenosis. For this purpose, bifidumbacterin is used topically (5-10 doses per day) in the form of vaginal applications for 8 days or acylact in the form of vaginal suppositories for 10 days.

To correct immunity, especially with recurrent vulvovaginal candidiasis, immunostimulating drugs are often prescribed. It is advisable to also include drugs aimed at normalizing interferon status in the complex of treatment measures for patients with candidiasis infection. For this purpose, interferon inducer drugs (viferon, kipferon, cycloferon, etc.) may be recommended.

In conclusion, it should be noted that the treatment of vulvovaginal candidiasis is a complex clinical problem. Its solution consists in eliminating or reducing the severity of risk factors and background genital and extragenital diseases, as well as prescribing maintenance antifungal therapy to prevent relapses of the disease in the future.