Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Drugs-Limited View
- Ned Hoke (10 May 2003)
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Is re-infection the problem?
- Harvey J Marrable (12 May 2003)
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Systematic and team approach for resistant cases
- Dr Fawzia Sanaullah (19 May 2003)
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Not all vaginal discharge is thrush
- Chris Butler, Paul McWhinney (21 May 2003)
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Alternative Treatment for Candida Infections
- Sharon J Williams (5 June 2003)
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Ned Hoke, ecological med/private western us
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Recurrent infections indicate a disordered biology often systemic. While management of symptoms may be attractive to providers of products I suggest this author avail herself with contacts in her nearby naturopathic community for better and more lasting soultions < Competing interests: None declared |
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Harvey J Marrable, Psychiatrist in Private Practice Gosford N.S.W. 2250 Australia
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There is no interest expressed in this paper as to where the candida comes from in the first place. Has anyone tested the male partner for asymptomatic genital candidiasis? Or tried treating him with oral fluconazole concurrently with the patient? Competing interests: None declared |
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Dr Fawzia Sanaullah, Specialist Registrar Wansbeck General Hospital, Ashington, NE63 9JJ
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I am pleased to see an editorial on this common condition. I agree with the author's concern that it is not simply a nuisance infection. In our practice we deal with this condition every day and routine fungistatic ozole or nystatin cure most of the women. However, there remain a small proportion of the women who need systematic approach if routine over-the- counter or prescribed fungistatic treatment has failed. It can become a disabling condition affecting sexual relationship. Vulvovaginal cultures and self taken swabs before starting long term treatment and more advanced fungicidal treatment after systematic approach is important(1). At this stage an important isssue is to deliver good explanation to the women about the reason for treatment failure and different treatment regimen for chronic case. Empathy on the part of the doctor is very important. In some women life may be so much affected that psychosexual counselling may be required(2). In addition to this, multidisciplinary team approach between microbilogist, dermatologist and gynaecologist will improve future understanding , appropriate diagnosis and hopefully will help to improve future outlook (3) References: 1. Eckert LO, Hawes SE, Stevens CE, et al. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynaecol 1998;92:757-65. 2.IrvingG, Miller D, Robinson S, Copas AJ. Psychological factors associated with recurrent vaginal candidiasis: a preliminary study. Sex Transm Infect 1998;74:334-8. 3. Sobel JD. pathogenesis and treatment of recurrent vulvovaginal candidiasis. Clin Infect Dis 1992;14Suppl 1:148-53. Competing interests: None declared |
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Chris Butler, Associate specialist St Luke's Hospital Bradford BD5 0NA, Paul McWhinney
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Editor - The recent article by Jeanne Marrazzo on vulvovaginal candidiasis raises many issues in our understanding of this common infection1. We would like to make some further observations on the epidemiology of this and clinically similar syndromes seen in our clinic. The diagnosis of a vaginal discharge with vulval irritation is difficult without microscopy. The presence of a discharge with an offensive smell and a pH > 4.5 suggests bacterial vaginosis (BV). Trichomonas vaginalis infection (TV) can produce vulval irritation and discharge, which is best diagnosed by microscopy. In this clinic, where microscopy is available for every patient, BV, TV and candidiasis can be diagnosed in 10–15 minutes. Candida infections are confirmed by culture. The numbers of confirmed cases are plotted using an Excel spread sheet and a trend line added. Our prevalence for both Candida and BV is at present 25%.This figure for Candida compares with the figure reported by Marrazzo for recurrent vulvovaginal candidiasis. However, these figures are for overall prevalence and do not distinguish between acute or recurrent episodes. It does mean, however, that 1:4 of the women sitting in our waiting room will have Candida, BV or sometimes both, a considerable problem and source of great inconvenience for women. Our prevalence for TV, 3%, is high for this region. Of these three infections only TV is considered sexually transmitted, and is the only one requiring contact tracing and treatment of partners. From the trend lines it would appear that the prevalence of Candida is decreasing and for BV increasing. The trend for TV is remarkably constant. At a time when awareness of fungal infections is rising, the apparent decline in Candida infection is striking. One in four women is suffering from BV, Candida or both. Quite apart from the inconvenience there are more serious health implications. BV increases the risk of late miscarriage, preterm birth, preterm rupture of membranes and postpartum endometritis. BV may also facilitate the transmission of viruses such as HIV2. The long term consequences of Candida infection are less well understood. Of these three infections only TV is sexually transmitted, requiring contact tracing and treatment of partners. TV is also associated with preterm delivery and low birth weight. Clearly the accurate diagnosis of vaginal discharge, based on microscopy and culture is important. Not all vaginal discharges are due to Candida and the endless prescribing of azoles will not always help. The apparent decline raises many epidemiological questions. Dr Chris Butler, associate specialist, GU medicine Dr Paul McWhinney consultant, infectious diseases Department of Sexual Health and Infectious Diseases, St Luke’s Hospital,
Bradford, BD5 0NA, W.Yorks.
1 Marrazzo J Vulvovaginal candidiasis BMJ 2003 ;326:993-4 2 Sewankambo N et al : HIV –1 infection associated with abnormal vagina flora morphology and bacterial vaginosis. Lancet 1997; 350:546 Competing interests: None declared |
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Sharon J Williams, Retired Registered Nurse N/A
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In the past, I have had Candida infections treated with creams and tablets inserted in the vagina. The tablets do not dissolve properly as advertised and therefore do not work. I have also been treated for systemic Candida with 3 months of Nystatin, with no apparent effect. There is a better, more cost-effective way. I find that Homeopathic drops under the tongue several times a day for 3 - 5 days will cure these infections more quickly and with less mess and aggravation. Use of this method also seems to help the body become more resistant to future infections. About 80% of people respond to homeopathic remedies. Competing interests: None declared |
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