Candidiasis is not the same as ‘toilet disease’

In my last piece, I talked about the feedback I received from a female reader who said she has been having whitish vaginal discharge since 2010, which she said comes and goes after undergoing different types of treatment.

She made two requests, the first being a request for a drug prescription; while the second was a request to send her a reply through the e-mail platform.

The first request was turned down because prescription by proxy is against the ethics of the medical profession.

A young lady who has similar symptoms with the scenario described above came for a consultation, with the history of whitish vaginal discharge. The following conversations took place during the consultation:

Doctor: Good day, how may I help you?

Patient: I have TD

Doctor: TD? What is TD?

Patient: TD means toilet disease.

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Doctor: What is toilet disease?

Patient: Toilet disease is infection, itching, whitish vagina discharge; these are the symptoms I am having.

Doctor: These are symptoms of candidiasis and are not likely gotten from the toilet.

Just the way this young lady thought she has toilet disease, a lot of women out there also believe that the vagina discharges they sometimes experience is associated with toilet use.

Women have a wrong notion that when they have vaginal discharge or itching, it is acquired from the toilet. This is not a true statement.

However, conditions that lead to these symptoms are, most times, not contacted by using dirty toilets but rather are either sexually transmitted or through poor hygiene or transmitted through fomites or through intimate contact with the clothing of people who have such conditions.

People, especially women, do not have to worry about contracting sexually-transmitted diseases such as herpes, gonorrhoea, syphilis and HIV through dirty toilet seats.

This is because these diseases are spread via unprotected skin-to-skin sexual contact. Most of the viruses or bacteria that cause them die very quickly outside the body; so it is very unlikely that they can be transmitted through a dirty toilet seat.

Yeast infection (candidiasis) is a common problem in women and some men. It can be seen in the vagina, vulva, mouth and on the skin, especially in moist areas. It can be present in the body for a long time without any obvious symptoms.

Yeast infection (candidiasis) can also be sexually transmitted. Men tend to be sometimes free of symptoms but should be treated, especially if the condition is recurrent.

Vaginal thrush, also known as vaginal yeast infection, is an inflammation caused by a type of yeast called Candida albicans.

Vaginal thrush is very common and about three in four women will have at least one episode of thrush at some point during their life.

Vaginal thrush can keep coming back. Having thrush symptoms more than four times in a year is known as recurrent infection.

Causes

Vaginal thrush is caused by an increase in the amount of Candida albicans in the vagina.

There are several conditions which make vaginal thrush more likely, including a weak immune system and poor nutrition.

Hormonal changes (for example, pregnancy), oral contraceptives, medication side effects, especially antibiotics and steroids, are also causative factors.

Medical conditions such as diabetes, human immunodeficiency virus infection (HIV), immune suppression, some cancers and their treatment, wearing tight-fitting clothes, synthetic underwears, etc., are all possible reasons why people develop candidiasis.

Signs and symptoms

Some people may not have any symptoms, so they may not even realise that they have vaginal thrush. However, possible symptoms can include vaginal itch, which is often worse at night; soreness, discomfort and irritation, thick and white vaginal discharge.

They may also experience pain during sex or while passing urine, vaginal discharge, redness and/or swelling of the vagina or vulva, stinging or burning when passing urine, cracked skin, and swelling.

The symptoms can be confused with bacterial vaginosis or trichomonas infection, genital herpes or urinary tract infection.

Bacterial vaginosis causes a greyish, frothy white discharge but also causes fishy odour; while trichomonas vaginalis causes greenish frothy discharge.

All three infections cause vaginal and vulval itching and soreness and are often misdiagnosed.

Case study

Miss Yetunde is a fresh graduate who was diagnosed with candidiasis. She went for vagina swab culture in the laboratory on her own. The result came out to be heavy growth of yeast, confirming the diagnosis of candida albican.

She was placed on both pessaries and oral antifungal for the candida. Today, the story is different, as she feels very okay and well.

Diagnosis

Candidiasis is the commonest cause of vulvovaginitis and can be confirmed by microscopic examination and growth of yeast from a swab from the vagina.

The importance of having a vaginal swab taken before starting any treatment needs to be particularly emphasised to the patient because laboratory confirmation of each suspected infection is an integral part of the management.

Women should be advised to have a vaginal swab taken whenever they suspect a recurrence.

A glucose test and an HIV test should also be done in cases of recurrent yeast infections.

Treatment

Specific treatment for candidiasis involves inserting an antifungal pessary into the vagina when the patient is symptomatic.

A pessary is a small tablet that’s inserted into the vagina. Many preparations are effective in the treatment of candidiasis. A vaginal imidazole, inserted nightly for one week, is recommended as the standard treatment for candidal vulvovaginitis.

The use of an oral form of treatment, combined with vaginal pessaries and a cream for external itching, will definitely help to reduce recurrence.

Patients with recurring infections may need long-term prophylaxis with an oral antifungal drug. The diagnosis must be reviewed if patients do not respond to treatment.

Patients with frequently recurring thrush should seek medical advice to make sure they do not have a medical condition such as diabetes, HIV or immunosupression.

Some women are placed on long-term vaginal and oral antifungal treatment. This therapy may be continued for six months in the more troublesome cases.

Pregnant women who have had more than one proven infection during their pregnancy will also benefit from vaginal antifungal pessaries.

Male sexual partners of women with thrush do not require treatment, except very occasionally when a woman has recurrent infections or when the male has a rash or a sore penis.

Complications of vaginal thrush

Persistent thrush infection may be difficult to control and requires repeated treatments. Recurrent infections can cause discomfort and affect sex life. Women affected may feel down or anxious because of this.

Prevention

The following tips may help to reduce the risk of vaginal thrush:

• Wearing of cotton underwear and loose-fitting clothing.
• Avoidance of contributing factors (e.g., douching, wearing tight pants, using perfumed soap or bath cream).
• Avoid use of products that irritate the vulv area, including antiseptics or disinfectants, as these may disturb the natural protective acidity of the vagina.
• Women should always wipe from front to back after using the toilet, to avoid spreading yeast from the anus to the vagina.
• Women should practise hanging of their underwear in the sun to help in the reduction of persistent yeast infections when convenient and appropriate.