Does everyone have candidiasis, is that true?

No. Although the mushrooms that can cause candidiasis live on the skin and mucous membranes of about 50% of people, the disease does not develop in every carrier.

Nevertheless, this is a common illness that can cause a lot of discomfort, and it is not always easy to cure. To avoid problems, it is important to consult a doctor as soon as possible when unpleasant symptoms appear.

What is candidiasis?

Candidiasis is an infection caused by microscopic yeast fungi of the genus Candida. In nature, there are more than 160 species of these fungi, but only 20 of them cause candidiasis in humans. Candida albicans is often associated with this infection.

How Candida develops. In normal conditions, the immune system keeps the reproduction of yeast fungi under control. As long as immunity is in charge, fungi live on the skin, mucous membranes, in the gastrointestinal and urogenital tract of many people, without causing harm to them.

But sometimes mushrooms start to reproduce quickly, for example, against the background of a serious illness, due to the weakened immune control over yeast mushrooms, or as a result of prolonged use of antibiotics, which reduces the number of beneficial microorganisms competing with fungi.

Then they attach to the surface of host cells and release enzymes that help absorb nutrients from the intercellular space and from the cells themselves. To protect the cells, the immune system produces cytokines – fighting substances that not only destroy fungi but also cause inflammation in the tissues in which they have infiltrated. If the immune system manages to suppress the reproduction of yeast fungi, the disease will pass. But if the immune system is not strong enough, the person will not be able to recover without medication.

What is candidiasis like. How dangerous a yeast infection will be depends on a person’s immune system.

People with severely weakened immune systems may develop invasive candidiasis. For example, in people with HIV who are not receiving antiretroviral therapy, in those who have recently undergone organ transplantation, or in those who are being treated with chemotherapy drugs.

In this condition, yeast fungi enter the bloodstream and spread throughout the body with it. From the blood, fungi penetrate into the eyes, joints, heart, lungs, and other organs, and can cause serious damage to them. In some cases, invasive candidiasis can lead to a person’s death.

But for most people without serious health problems, the immune system does not weaken so much that fungi can “break through” into the blood. They experience local skin and mucosal infections, during which fungi settle in folds of the skin, between the toes, and nails, on the mucous membranes of the mouth or genitals, but do not penetrate deep into the body.

One of the most common types of candidiasis is local skin and mucous membrane infections of the genitals, commonly referred to as thrush. This disease is not considered a sexually transmitted infection, as it can occur in people who do not engage in sexual activity. However, if a person without thrush engages in unprotected oral, vaginal, or anal sex with a partner who has the disease, they are also at risk of infection.

Unlike invasive candidiasis, thrush does not damage organs and does not threaten life, but it can cause discomfort and recur. We will now specifically discuss it.

Who can get a yeast infection?

Thrush can occur in people of any gender. Candidal infection of the skin and mucous membranes in the genital area in women is called vulvovaginal candidiasis. The same condition in men is called candidal balanitis.

At the same time, candidal infection of the genital organs occurs more frequently in women than in men. According to statistics, at least once in their lifetime 75% of women will experience it.

Risk factors for vulvovaginal candidiasis in women. In some women, candidiasis may occur without clear external causes. However, the disease often has triggering factors, among which the most common are:

• The use of broad-spectrum antibiotics is the most common contributing factor, as Candida vulvovaginitis develops in 25-33% of women due to antibiotics.
• Diabetes mellitus. Women who poorly control their blood glucose levels with medication are more prone to the disease.
• Immunodeficiency. Women living with HIV infection or taking immune-suppressing drugs such as glucocorticoids are more likely to develop the disease compared to their peers without these conditions.
• High estrogen levels. Pregnant women and those taking estrogen-based medications during postmenopause are more susceptible to the disease compared to non-pregnant women of reproductive age.
• Genetic characteristics. Some women with variations in the SIGLEC 15 and TLR2 genes, which encode proteins involved in cell membrane structure, have a higher incidence of Candida vulvovaginitis compared to women with typical gene structures.

In addition, experts from the American Office of Women’s Health believe that the risk of developing Candida vulvovaginitis is increased by two more factors.

1. Incorrect clothing choices can contribute to the development of candidal vulvovaginitis. Synthetic underwear and tight-fitting clothes can increase body temperature and moisture in the genital area. Since yeast fungi from the Candida genus thrive in warm and moist conditions, it makes sense to wear cotton underwear and choose looser-fitting clothing to prevent candidal vulvovaginitis.
2. Improper hygiene practices of the genital area can also increase the risk of developing the disease. For example, infrequent changing of pads and tampons, douching (a procedure that removes normal bacteria from the vagina), and wiping the perineal area from the anus towards the vagina can introduce fungi from the rectum to the mucous membranes.

Risk factors for candidal balanitis in men. Like in women, the risk of developing Candida infection is higher in men who take antibiotics for long periods of time, suffer from immunodeficiency, and diabetes.

But there are also unique risk factors, such as excess weight and poor personal hygiene. Therefore, some experts believe that men who have not undergone circumcision are at a higher risk of developing candidal balanitis than those who have undergone the procedure.

Symptoms of thrush.

In women. Typically, women with vulvovaginal candidiasis complain of itching, burning or irritation in the vulva and vagina area. Pain often occurs during sexual intercourse, and itching and other unpleasant sensations can intensify.

The genitals appear swollen, and the mucous membranes seem redder than usual. In addition, some women may experience thick, white, cottage cheese-like vaginal discharge without an unpleasant odor that sticks to the walls of the vagina. However, there may be no discharge, or it may be scarce.

In men. Typically, men with candidal balanitis complain of inflammation, pain, and irritation in the area of the glans penis, and thick white lumpy discharge appears between the penis and the foreskin.

Some men with candidal balanitis complain of pain during urination and may have difficulty retracting the foreskin.

Diagnosis of thrush

The diagnosis of candidal skin and mucous infections of the genitals is similar for women and men. In both cases, a gynecologist or urologist makes a diagnosis based on an external examination of the skin of the genitals and an analysis of a discharge sample.

The easiest and quickest method is microscopic examination, during which a specialist looks for fungi in a stained sample under a microscope.

This method is not very accurate because the microscope’s field of view may not capture any yeast fungi. A more accurate method is cultivation, in which the sample is cultured on a nutrient medium and then the type of fungus that grows on it is determined. However, fungi grow for up to 7 days, so the result will have to be waited for quite a long time.

Therefore, in practice, most doctors prefer fast and accurate PCR tests. These are the tests that help to detect the genetic material, i.e. DNA or RNA, of the pathogen in the sample.

Microscopic examination and seeding of the biological material sample requested by the doctor are usually done for free with an OMS policy. However, since equipment and reagents for PCR are not available in all government laboratories, these tests usually have to be done in private laboratories for money

What tests does a doctor prescribe when suspecting a yeast infection

The number and type of tests will depend on the diagnostic hypothesis. If the doctor believes that the cause of the problem is a typical fungal infection, they will only prescribe a laboratory PCR test on a smear to determine the DNA of Candida albicans.

However, sexually transmitted infections have no specific symptoms. To ensure that candidiasis does not “disguise” a sexually transmitted infection, doctors usually give referrals for basic STI tests: these are PCR tests for gonorrhea, trichomoniasis, chlamydia, and genital mycoplasma, as well as blood tests for syphilis, HIV, hepatitis B and C.

In case of recurrent vulvovaginal candidiasis, a PCR test for atypical fungi may be needed: most often it is Candida tropicalis, Candida parapsilosis, and Candida glabrata, but other pathogens may also be included in the diagnostic panel. The disease is considered recurrent if a woman has three or more candidiasis exacerbations per year.

In addition to laboratory PCR tests, there are also home vaginal test systems that detect antigens to Candida fungi in women. However, they should not be used before consulting a doctor.

The accuracy of these tests is about 90%, so they may be wrong and give a false negative result. But even a positive result does not indicate the causes of the disease – since yeast live in the vagina of many women without causing harm. And if the infection is really caused by yeast, a vaginal test will not be able to determine which type of yeast it belongs to. That is, it is not possible to clarify the diagnosis and select the correct treatment using express tests.

Treatment of a yeast infection

There are many antifungal drugs that are suitable for treating candidal infections of the genital area in men and women. Typically, men are prescribed tablets, while women are prescribed either tablets or local remedies such as vaginal suppositories or creams. The effectiveness of tablets and suppositories is approximately the same.

Many “against thrush” drugs – for example, those based on the popular antifungal drug fluconazole – are available without a prescription, and only one or two tablets need to be taken. However, since antifungal drugs are very easy to buy, the same thing happens with them as with antibiotics: pathogenic fungi gradually lose sensitivity to them. Therefore, remedies that can be purchased without a prescription do not always help everyone.

Even to those people who are absolutely sure that the infection was caused by a fungus, not a STI, it still makes sense to consult a doctor before buying medication. If a traditional antifungal remedy doesn’t help, the specialist will choose an individual treatment plan that will help to cope with yeast fungi resistant to antifungal drugs.