Vaginal infections, more frequent than you might think

In Mexico, according to the update of the Clinical Practice Guideline made by the Mexican Social Security Institute in 2019, vaginal infections affect nine to 545 women per 100,000 inhabitants, mainly in the 20 to 24 age group who are of productive and reproductive age. It is estimated that 75 percent of them in the world will have at least one episode of vulvovaginal candidosis in their lifetime, and 10 percent, four per year.

According to Edith Sanchez Paredes, a researcher at the Faculty of Medicine (FM) of the UNAM, the bacterial type accounts for 50 percent of the total, while those caused by fungi account for 30 to 35 percent of the cases. It is estimated that 75 percent of the world's population will have at least one episode of vulvovaginal candidosis in their lifetime, and 10 percent will have four per year.

They are more common than you might think, affect people of all economic and social levels, and are caused by different microorganisms such as viruses, bacteria, fungi, and/or parasites. Even in the 21st century, some are still reluctant to talk to a doctor about their intimacy, either out of fear or embarrassment. Visits to the gynecologist are rare because they are uncomfortable, especially when dealing with issues of this nature.

Vulvovaginal candidosis is a disease caused by opportunistic yeasts of the genus Candida that affect the vaginal mucosa and vulvar skin; the species C. Albicans is responsible for 80 to 90 percent of cases; however, other species such as glabrata, krusei, guilliermondii, tropicalis, and parapsilosis can also cause it. It is considered the most frequent opportunistic infection in fertile age because it rarely occurs before this stage or after menopause.

"Probably when women associate this type of infection only with the genital area or with sexually transmitted diseases, they think they will be judged and stop going to the doctor; or worse, they self-medicate, causing them to become more complicated. However, Candida spp is not only found in the vaginal tract, but also in the mucous membranes of the mouth, the digestive tract, and even in the lungs," she emphasized.

The also member of the Department of Microbiology and Parasitology indicated that it is part of the microbiome of the skin and mucous membranes of the human being, fulfilling a physiological function by being associated with other bacteria and fungi to perform vital functions for the homeostasis (self-regulation) of the genital tract.

When women are healthy there is no problem with this yeast because it can live harmoniously; but it can proliferate its growth when broad-spectrum antibiotics are used, they are immunologically weakened, have vaginal pH changes, hormonal disorders, and/or diabetes mellitus. The causes of vulvovaginal candidiasis are complex and multifactorial.

Cases of invasive candidosis (another clinical form) have been reported in patients with COVID-19, especially in patients admitted to intensive care units, requiring mechanical ventilators, with catheters, and with multiple antiviral and/or antibiotic treatments, which may contribute to a decrease in their immune response and Candida behaves as an opportunist, affecting various organs such as the lungs, heart and/or digestive system.

Treatment and prevention

Candida can occur weeks before menstruation, causing burning, itching, vaginal pain, vaginal discharge, and discomfort during sexual intercourse or urination. If it is not treated in time, it can become a chronic process, the symptoms increase and if the treatments recommended by the doctor are not followed properly, strains resistant to antifungals may be generated. Particularly when untreated, vulvovaginal candidiasis can lead to pelvic inflammatory disease, ectopic pregnancy, pelvic abscess, miscarriage, and menstrual disorders.

Medical management depends on the severity of the symptoms and the recurrence of infections, but basically, it is carried out through medications based on creams or lozenges; sometimes sensitivity tests are performed, in which Candida spp. colonies are cultivated and face several antifungals to find out which one inhibits the growth of the fungus. For its treatment, one more alternative is under investigation, a vaccine for recurrent vulvovaginal Candidosis, an alternative based on fungal molecules considered virulence factors and which confer its pathogenic capacity to the yeast. Two, in particular, have been studied, but only one has passed to Phase 2.

As a preventive measure, it is important to wear cotton underwear, avoid tight clothing, do not self-medicate and when any discomfort occurs, go to the doctor who will determine which laboratory study to perform on each patient to establish what it is, since sometimes it is caused by other factors, such as the use of certain soaps, humidity, and heat. "Candida is a yeast that beyond giving us problems will benefit the body, therefore we must take care of our intimate health as well as the general, by attending the doctor with some frequency," concluded Sanchez Paredes.