Candidiasis

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Candidiasis (Thrush, Yeast Infection)

What is Candidiasis?

Candidiasis is the term for infections caused by the yeast Candida. These infections can involve the throat, esophagus, vagina, or skin. Thrush refers to infection in the mouth. Esophagitis describes infection spreading from the throat to the esophagus. Vaginitis (also known as "yeast infection") refers to infection of the vagina.

The mouth normally contains many microorganisms. One of these normal microorganisms is the fungus Candida albicans, which is the same fungus associated with vaginal yeast infections or other Candida infections. The growth of Candida is normally kept under control by the presence of normal bacteria.

Uncontrolled overgrowth of Candida in the mouth may be caused by factors that reduce the natural resistance, such as illness, stress, steroids or medications that suppress the immune system, and immune disorders such as AIDS. It may also be caused by conditions that upset the balance of normal microorganisms in the mouth. This is most commonly associated with use of antibiotics but it may also occur with uncontrolled diabetes mellitus and with the hormonal changes associated with pregnancy or the use of birth control pills.

Candida organisms are often present in small numbers in the mouth, digestive tract, vagina, and skin of healthy persons, but they usually do not cause infection. A weakened immune system makes it easier for Candida to grow, as do many antibiotics that are given at the time of surgery that kill bacteria which normally compete with Candida for growth. Diabetes mellitus and steroid therapy are other risk factors for Candidiasis.

What are the symptoms and signs of Candidiasis?

Candidiasis may cause soreness or a bad taste, or it may be without symptoms altogether. It often looks like creamy white patches similar to cottage cheese. Candidiasis sometimes appears as red spots on the tongue or roof of the mouth. Cracks and redness of the skin at the corners of the mouth may also occur. Candida esophagitis is often associated with difficulty swallowing and discomfort or pain in the chest. Candida vaginitis typically causes a thick white discharge, discomfort at the front of the vaginal opening during urination, and irritation and swelling of the vaginal lips (labia). Candidiasis in skin folds may result in itching, redness or darkening, and discharge. It generally occurs in the groin area, in the armpits, or under the breasts.

How is it diagnosed?

Most types of Candidiasis are diagnosed by how they look. Candida vaginitis can be diagnosed by examining the vaginal discharge under a microscope. Material scraped from the mouth or skin folds can also be examined in this manner.

Candida esophagitis is presumptively diagnosed if thrush is present and the patient has pain with swallowing.

How is Candidiasis treated?

Medical therapy of Candidiasis can be topical or systemic. Topical treatment means applying medication directly to the infected area using a cream, a suppository (a type of medicine that is inserted into the vagina), a liquid suspension, or a troche/lozenge (medicine in a tablet form that is dissolved in the mouth).

For most forms of Candidiasis, topical treatment usually works well and should be tried first, before resorting to systemic treatment.

Nystatin 600,000 units swish and swallow four times a day, continued until 48 hours after disappearance of symptoms (usually within 3-5 days).

Clotrimazole comes in lozenge, topical cream and solution formulas, as well as over-the-counter vaginal cream and tablet form. Clotrimazole is the most common topical treatment for thrush. A 1% solution is applied twice daily. Clotrimazole comes in 10 mg lozenges that are held in the mouth until they dissolve, 5 times daily. For vaginal fungal infection, 100 mg tablets daily for 7 days or 200 mg for 3 days (non-pregnant only) are prescribed. If the infection is uncomplicated, you may be treated with one 500 mg dose, or 5 g of 1% vaginal cream daily for 7-14 days. Vaginal preparations should be used at bedtime for maximum contact with mucous membranes. If you miss a dose, do not double doses.

Fluconazole (Diflucan) 100 mg one tablet by mouth daily for 14 days is very effective and convenient but expensive.

Good oral hygiene is important to aid healing. Patches may be gently brushed off with a toothbrush. Warm salt water rinses (1/2 teaspoon of salt in one cup of water) may be soothing. Some patients have found that alternative or complementary treatments may help prevent Candidiasis. These include gargling daily with an antiseptic mouthwash or eating yogurt that contains live acidophilus.

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