What is vulvovaginal candidiasis?
VVC (commonly referred to as a yeast infection) is a common vaginal fungal infection caused by the overgrowth of Candida species (most often C. albicans). An estimated 70%–75% of women experience one episode of VVC in their lifetime, and 5%–8% of women are affected by recurrent VVC (defined as four or more episodes in one year).
Uncomplicated VVC infections are generally infrequent, mild-to-moderate in severity, occur in women with normal immune function, and resolve with treatment because they're most often caused by the antifungal-sensitive species C. albicans. Complicated VVC, however, is characterized by severe, recurrent episodes that occur in women with diseases that increase their risk of infection and are caused Candida species that are harder to treat.
What are the main signs and symptoms of VVC?
The most common sign of VVC is an abnormal discharge that may be thick or watery and resembles cottage cheese. Unlike other vaginal infections, this discharge isn’t associated with a strong odor, and vaginal pH is normal. Symptoms may include vaginal or vulvar itching, irritation, soreness, redness, swelling, and burning sensations, but VVC can also be asymptomatic.
How is VVC diagnosed?
After performing a medical examination of the vulva and vagina, a medical practitioner will collect a sample of vaginal discharge to observe under a microscope, which allows them to apply a specific solution that makes it possible to see hyphal Candida (the form in which they can cause disease).
If a woman has symptoms of VVC but the microscopy doesn’t reveal any Candida, another sample may be applied to a cell culture plate that promotes microbial growth, and if Candida are present, they will be observable in a few days.
What are some of the main medical treatments for VVC?
Antifungal drugs, which work by changing the permeability of the fungal cell membrane, are the most effective treatment option for VVC. Both oral and topical antifungal medications treat the symptoms of VVC, but topical antifungals are more effective at reducing Candida colonization and are also available without a prescription.[1]
The most widely used antifungal drugs are azoles, such as ketoconazole and fluconazole (both of which are available over the counter). Prescription antifungal drugs may be more effective for infections caused by species other than C. albicans.[1]
Have any supplements been studied for VVC?
Some studies suggest that certain probiotic strains or vitamin B complex could enhance the treatment effects of antifungal drugs.[2]
A number of other topical or suppository supplements have also been studied alone or in combination with antifungal treatments, including yogurt, honey, boric acid, ginger, and curcumin. Though some treatments were more effective than placebo and appeared comparable to antifungal treatments, many of the trials have considerable limitations.
How could diet affect VVC?
The presence of oral probiotics and food-based microbes in stool and vaginal samples indicate that ingested microbes can be transferred to the vagina (likely due to its proximity to the rectum).[3] In a few small studies, some women exhibited lower Candida colonization and had fewer episodes of VVC after eating yogurt each day for several months, but these results were inconsistent.[4]
Limited evidence suggests that diets low in sugary foods and beverages could be a protective factor, but without controlling for other variables, no firm conclusions can be drawn about the relationship between dietary sugar intake and VVC.[5]
Are there any other treatments for VVC?
One study found that undergarments made of cotton or medical-grade silk infused with an antimicrobial compound improved the symptoms and recurrence of yeast infections in women receiving antifungal treatment. [6]
What causes VVC?
Under normal circumstances, Lactobacilli bacteria are dominant microbes of the vaginal microbiome, but there are a number of factors that can disrupt the balance and provide Candida with an opportunity to multiply, including hormonal changes during puberty or pregnancy, uncontrolled diabetes, immunosuppression, and the overuse of antibiotics.[5]
Weaker evidence suggests that other behaviors could also increase the risk of VVC, such as the use of estrogen-containing oral contraceptives, spermicides, douching, and frequently wearing tight, synthetic pants or undergarments (e.g., leggings, damp swimsuits).
VVC isn’t a sexually-transmitted disease (because it isn’t contracted exclusively through sexual activity) but it may be possible to contract it from a sexual partner. Condoms and hygienic sexual practices (like washing both sex toys and the external genitalia before and after sexual activity) can help prevent VVC from occurring by reducing the transfer of abnormal (or fecal) microbiota into the vagina.[4]
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Frequently asked questions
VVC (commonly referred to as a yeast infection) is a common vaginal fungal infection caused by the overgrowth of Candida species (most often C. albicans). An estimated 70%–75% of women experience one episode of VVC in their lifetime, and 5%–8% of women are affected by recurrent VVC (defined as four or more episodes in one year).
Uncomplicated VVC infections are generally infrequent, mild-to-moderate in severity, occur in women with normal immune function, and resolve with treatment because they're most often caused by the antifungal-sensitive species C. albicans. Complicated VVC, however, is characterized by severe, recurrent episodes that occur in women with diseases that increase their risk of infection and are caused Candida species that are harder to treat.
Bacterial vaginosis (BV) and yeast infections are the two most common vaginal infections. Unlike yeast infections, which are caused by an overgrowth of fungus, BV is caused by an imbalance in vaginal bacteria characterized by low levels of lactobacilli.
Yeast infections and BV have similar symptoms, including unusual discharge and vaginal irritation, but unlike a yeast infection, BV is often associated with an odor and abnormal vaginal pH. They’re treated with different medications, because yeast infections require antifungal drugs while antibiotics are prescribed for BV.
They also share some of the same risk factors, including douching and pregnancy-related hormonal changes. Like yeast infections, BV can develop due to unprotected sex with new or multiple partners, because semen temporarily changes the vaginal pH (making it more susceptible to infection).[8]
The most common sign of VVC is an abnormal discharge that may be thick or watery and resembles cottage cheese. Unlike other vaginal infections, this discharge isn’t associated with a strong odor, and vaginal pH is normal. Symptoms may include vaginal or vulvar itching, irritation, soreness, redness, swelling, and burning sensations, but VVC can also be asymptomatic.
After performing a medical examination of the vulva and vagina, a medical practitioner will collect a sample of vaginal discharge to observe under a microscope, which allows them to apply a specific solution that makes it possible to see hyphal Candida (the form in which they can cause disease).
If a woman has symptoms of VVC but the microscopy doesn’t reveal any Candida, another sample may be applied to a cell culture plate that promotes microbial growth, and if Candida are present, they will be observable in a few days.
Over-the-counter vaginal pH tests can’t be used to diagnose specific conditions, but they are valid screening tools. These tests change colors to show the pH of vaginal discharge, which can help users discern whether they might have a bacterial infection or a yeast infection. These tests are fairly accurate (up to 90%) and can help users make informed decisions about pursuing further treatment.[8]
Antifungal drugs, which work by changing the permeability of the fungal cell membrane, are the most effective treatment option for VVC. Both oral and topical antifungal medications treat the symptoms of VVC, but topical antifungals are more effective at reducing Candida colonization and are also available without a prescription.[1]
The most widely used antifungal drugs are azoles, such as ketoconazole and fluconazole (both of which are available over the counter). Prescription antifungal drugs may be more effective for infections caused by species other than C. albicans.[1]
Some studies suggest that certain probiotic strains or vitamin B complex could enhance the treatment effects of antifungal drugs.[2]
A number of other topical or suppository supplements have also been studied alone or in combination with antifungal treatments, including yogurt, honey, boric acid, ginger, and curcumin. Though some treatments were more effective than placebo and appeared comparable to antifungal treatments, many of the trials have considerable limitations.
The presence of oral probiotics and food-based microbes in stool and vaginal samples indicate that ingested microbes can be transferred to the vagina (likely due to its proximity to the rectum).[3] In a few small studies, some women exhibited lower Candida colonization and had fewer episodes of VVC after eating yogurt each day for several months, but these results were inconsistent.[4]
Limited evidence suggests that diets low in sugary foods and beverages could be a protective factor, but without controlling for other variables, no firm conclusions can be drawn about the relationship between dietary sugar intake and VVC.[5]
One study found that undergarments made of cotton or medical-grade silk infused with an antimicrobial compound improved the symptoms and recurrence of yeast infections in women receiving antifungal treatment. [6]
Under normal circumstances, Lactobacilli bacteria are dominant microbes of the vaginal microbiome, but there are a number of factors that can disrupt the balance and provide Candida with an opportunity to multiply, including hormonal changes during puberty or pregnancy, uncontrolled diabetes, immunosuppression, and the overuse of antibiotics.[5]
Weaker evidence suggests that other behaviors could also increase the risk of VVC, such as the use of estrogen-containing oral contraceptives, spermicides, douching, and frequently wearing tight, synthetic pants or undergarments (e.g., leggings, damp swimsuits).
VVC isn’t a sexually-transmitted disease (because it isn’t contracted exclusively through sexual activity) but it may be possible to contract it from a sexual partner. Condoms and hygienic sexual practices (like washing both sex toys and the external genitalia before and after sexual activity) can help prevent VVC from occurring by reducing the transfer of abnormal (or fecal) microbiota into the vagina.[4]
Yeast infections are more common during the luteal phase of the menstrual cycle (the stage after ovulation, leading up to the first day of your period).
Though the mechanisms aren’t clear, researchers attribute this to the elevated levels of estrogen, which could support the proliferation of C. albicans by increasing glycogen (stored carbohydrates, which are a nutrient for the yeast) in the vaginal cells, suppressing vaginal immune cell function, and/or promoting the transition of Candida from its yeast to hyphal forms.
This could also explain why yeast infections are more common during pregnancy and post-menopausal hormone replacement therapy.[7]
References
- ^Hayley J Denison, Julia Worswick, Christine M Bond, Jeremy M Grimshaw, Alain Mayhew, Shakila Gnani Ramadoss, Clare Robertson, Mary Ellen Schaafsma, Margaret C WatsonOral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush)Cochrane Database Syst Rev.(2020 Aug 24)
- ^Mei-Guo Sun, Ying Huang, Yuan-Hong Xu, Yun-Xia CaoEfficacy of vitamin B complex as an adjuvant therapy for the treatment of complicated vulvovaginal candidiasis: An in vivo and in vitro studyBiomed Pharmacother.(2017 Apr)
- ^Amelie Decherf, Elodie Dehay, Mickaël Boyer, Mathieu Clément-Ziza, Bertrand Rodriguez, Sophie Legrain-RaspaudRecovery of Saccharomyces cerevisiae CNCM I-3856 in Vaginal Samples of Healthy Women after Oral AdministrationNutrients.(2020 Jul 24)
- ^Office on Women’s Health in the U.S. Department of Health and Human Services
- ^Xianling Zeng, Yafei Zhang, Taohong Zhang, Yan Xue, Huiqiu Xu, Ruifang AnRisk Factors of Vulvovaginal Candidiasis among Women of Reproductive Age in Xi'an: A Cross-Sectional StudyBiomed Res Int.(2018 Jun 7)
- ^A D'Antuono, E Baldi, S Bellavista, N Banzola, S Zauli, A PatriziUse of Dermasilk briefs in recurrent vulvovaginal candidosis: safety and effectivenessMycoses.(2012 May)
- ^Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva SVulvovaginal candidiasis: Epidemiology, microbiology and risk factors.Crit Rev Microbiol.(2016-Nov)
- ^Lin YP, Chen WC, Cheng CM, Shen CJVaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis.Diagnostics (Basel).(2021-Oct-27)
Examine Database References
- Vaginal Infection Risk - Saffari E, Mohammad-Alizadeh-Charandabi S, Adibpour M, Mirghafourvand M, Javadzadeh YComparing the effects of Calendula officinalis and clotrimazole on vaginal Candidiasis: A randomized controlled trial.Women Health.(2017)
- Itching - Zakeri S, Esmaeilzadeh S, Gorji N, Memariani Z, Moeini R, Bijani AThe effect of Achillea Millefolium L. on vulvovaginal candidiasis compared with clotrimazole: A randomized controlled trial.Complement Ther Med.(2020-Aug)