Candidiasis

TREATMENTS OF SEXUALLY TRANSMITTED DISEASES

Candidiasis

In men, this disease is less common than in women and usually presents as an inflammation of the glans penis, in a condition known as balanitis.

Candidiasis
Candidiasis

Table of Contents

Candidiasis
definition

What is candidiasis?

Candidiasis is an infectious disease caused by a fungus of a type called Candida, most frequently by the species Candida albicans, which can be sexually transmitted.

In the majority of cases, the disease begins manifesting itself with the presence of pink plaques, itching and burning in the most superficial layer of skin in the mouth, lips and external genitalia, where it is most evident.

In men, this disease is less frequent than in women and usually presents as an inflammation of the skin at the end of the penis (the glans), a condition known as balanitis. Being a moist area, fungus can grow silently (and be transmitted during this time) until the body responds with inflammation.

Patients with weakened immune systems (such as HIV-positive patients or those with systemic lupus erythematosus) may develop severe infections of the oesophagus’ mucosa or other internal organs.

Although quite rare, these complications can occur. It is therefore important that diagnosis and treatment must be done at an early stage.

Candidiasis affects almost 3 out of 4 women at least once in their lifetime. However, it’s common for up to two episodes to occur in that period.

The ages at which the incidence of candidiasis is highest (in men and women) are between 20 and 40 years of age.

How is it transmitted?

Under normal conditions, the fungus candida albicans is part of the normal flora of the vagina, just like lactic acid bacteria (lactobacilli) and together, they maintain the biochemical environment of that area and prevent certain pathogenic microbes from invading the mucosa and causing disease.

What happens when a woman develops candidiasis is that there is a loss of that biochemical balance and a weakening of the mucous membrane, and certain microorganisms (such as candida albicans) can reproduce excessively and pass through that epithelium, causing an inflammatory immune response.

As there is an overpopulation of candida albicans, this fungus can be transmitted sexually (including vaginal or anal intercourse) and can, in turn, infect men in the area of the glans and penis (organs that normally should not have candida albicans as the usual flora).

By oral sex, candidiasis may affect the thin mucosa of the lips and the inner surface of the mouth (cheeks, gums, palate, oesophagus) in a condition known as oral candidiasis.

Candidiasis can also be transmitted vertically, i.e. from mother to child during childbirth, causing the neonatal variant of this disease.

symptomatology

What are its symotoms?

The symptoms produced by candidiasis vary depending on the anatomical location of the infection but, in general terms, there are red, itchy areas. In oral candidiasis, these plaques are white.

In women

In men

Oral candidiasis in men or women is characterized by whitish (pearly) and painful skin plaques in the buccal mucosa, fissures in the angles of the mouth (called cheilitis) and reddened tongue.

Can a contagion be asymptomatic?

In theory, almost one-fifth of the female population in the world has candida albicans as the usual vagina’s flora, without this leading to significant clinical manifestations (candidiasis itself).

Differences between men and women

Women are more predisposed to mycosis from candida albicans due to the conditions of the vagina, which is a warm, humid place. However, men are at greater risk of candidiasis because this yeast is not part of the normal flora of the penis.

Uncircumcised men are especially susceptible to candidiasis because the folds of the foreskin on the glans (balanopreputial sulcus) provide this humid and warm environment for the yeast to proliferate and invade the tissue.

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RISK FACTORs

Risk factors and how to prevent it

Among the risk factors that most increase a woman’s probability of getting candidiasis (developing the disease or spreading it during unprotected sex) are:

The prevention of candidiasis involves using latex condoms during sexual intercourse (especially with not regular partners), using cotton and loose-fitting underwear (to reduce groin humidity) and keeping healthy oral hygiene.

Diagnosis

How is it diagnosed?

Candidiasis is diagnosed by a physical examination of the patient to assess skin lesions on the external genitalia, mouth and other locations. The medical interview will be key to determine what triggered the infection: previous sexual relations, changes in hygiene habits, etc. In other cases, more specific tests such as cytologies and microbiological cultures may also be performed.

In men, it is common for the diagnosis of candidiasis to include a study of the intestinal mucosa and its usual flora.

diagnóstico en laboratorio

How to treat candidiasis

The treatment of candidiasis depends on its location. For example, for intertriginous candida albicans infections (in areas such as the external genitalia, in the armpits, in the pelvic region of obese patients or below the breasts) it is usual to use desiccant agents (such as compresses with Burow’s solution) in medical consultations, in order to eliminate mycosis.

Topical antifungals such as fluconazole and miconazole are also helpful. They are quite effective for treating candida and should be prescribed by a physician. Never self-medicate (at least not with oral drugs).

At the same time, and as many studies attest, chronic candidiasis requires a complete revision of the patient’s diet to eliminate an excess of blood’s glucose peaks, which is what usually feeds the colony of bacteria. These types of diets are very restrictive and include the elimination of many of the carbohydrates sources that we traditionally take, such as potatoes or rice.

How to treat candidiasis in breastfed babies?

Candidiasis in babies is characterized by redness, irritation and skin discomfort in the diaper area, similar to contact dermatitis (diaper rash). This condition may have been transmitted during childbirth or by handling.

This variant of candidiasis is treated with initial conservative measures (increased frequency of diaper changes, use of ultra-absorbent diapers, better hygiene of the area) and application of antifungal creams such as imidazole.

If the baby’s candidiasis is oral, it is treated with topical oral solutions with nystatin, another antifungal. This measure is also used in oral (buccopharyngeal) candidiasis in adults, with considerable success.

Are there any re-infections after treatment? Until when is it still transmissible?

There is no immunity to the disease from having had it before, so re-infections with candida albicans may not only occur in the future, but are quite common.

Women who develop candidiasis at some point in their lives usually have it again months or years later. This statistic is slightly lower for men.

However, the disease remains transmissible until antifungal treatments fulfil their function of eliminating the proliferation of fungi in the skin. It is therefore necessary that, for the duration of the treatment, couples have sexual relations with a latex condom.

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Frequent questions

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Can there be serious complications?

If the disease is not properly treated and the proliferation of fungi persists and increases with time, candidiasis may become chronic, resulting in excessive spread of the yeast to areas as distal as the palms of the hands or the nail folds of the feet (mucocutaneous candidiasis).

When does a mucocutaneous candidiasis become invasive and how is it treated?

This transformation of the initial clinical condition occurs in people with extremely weak immune systems, such as patients with HIV, uncontrolled diabetes or those receiving immunosuppressive treatments (cancer chemotherapy, steroids, anti-rejection of transplanted organs drugs, etc.).

What are the differences between candidemia and invasive candidiasis?

Invasive candidiasis is when the initial infection (in external genitalia, for example) spreads to sites as diverse as the kidneys, brain, eyes, or delicate heart valves. It occurs in people with very weakened immune systems or hospitalized patients.

However, candidemia is a severe septicemic state in which the yeast reaches the bloodstream and can reach almost any tissue or organ of the body. It usually follows medical procedures such as the implantation of inguinal venous catheters.

Candidemia always precedes invasive candidiasis.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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