Can a fungal vaginal infection cause polyuria?

Fungal Vaginal Infections and Polyuria: Clinical Connection

Fungal vaginal infections (vulvovaginal candidiasis) do not directly cause polyuria, and there is no established causal relationship between these conditions in the medical literature. 1, 2

Understanding Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) is a common fungal infection that affects approximately 75% of women at least once in their lifetime, with 40-45% experiencing recurrent episodes 1. The typical symptoms include:

• Pruritus (itching)
• Vaginal discharge (often white and thick)
• Vaginal soreness
• Vulvar burning
• Dyspareunia (painful intercourse)
• External dysuria (pain during urination) 1

It's important to note that while external dysuria (pain during urination) is a recognized symptom of vulvovaginal candidiasis, this differs from polyuria (increased urine volume) 1.

Diagnostic Considerations

VVC is diagnosed when a woman presents with symptoms and either:

• Wet preparation (saline, 10% KOH) or Gram stain shows yeasts or pseudohyphae
• Culture yields a positive result for a yeast species 1

VVC is associated with normal vaginal pH (<4.5) 1. Approximately 10-20% of women harbor Candida species asymptomatically, so the presence of yeast without symptoms is not an indication for treatment 1, 2.

Potential Confusion with Urinary Tract Symptoms

Several important distinctions should be made:

1. External dysuria vs. polyuria: VVC may cause pain during urination (external dysuria) due to irritation when urine contacts inflamed vulvar tissues, but this does not increase urine volume 1.

2. Fungal urinary tract infections: While fungal urinary tract infections (funguria) exist, they are rare in community settings and more common in hospitalized patients (10-30% of hospital urine cultures) 3. These are distinct from vulvovaginal candidiasis.

3. Diabetes connection: Patients with diabetes, especially those with poor glycemic control, are more prone to both genital mycotic infections and polyuria 4. In this case, diabetes is the underlying cause of both conditions rather than one causing the other.

Clinical Implications

When evaluating a patient with both vulvovaginal candidiasis and polyuria, clinicians should:

• Consider diabetes mellitus as a potential underlying cause for both conditions 4
• Evaluate for fungal urinary tract infection, which is distinct from vulvovaginal candidiasis 3, 5
• Assess for other causes of polyuria (diabetes insipidus, excessive fluid intake, diuretic use, etc.)

Treatment Considerations

For vulvovaginal candidiasis, treatment options include:

• Topical azoles: clotrimazole, miconazole, terconazole, etc. 1, 2
• Oral fluconazole: 150mg as a single dose for uncomplicated cases 2
• For recurrent cases: 10-14 days of induction therapy followed by fluconazole 150mg weekly for 6 months 1

For C. glabrata infections that don't respond to azoles, options include:

• Boric acid intravaginally (600mg daily for 14 days)
• Nystatin intravaginal suppositories (100,000 units daily for 14 days) 1

Key Takeaway

While a patient may present with both vulvovaginal candidiasis and polyuria, these conditions are not causally related. When both are present, clinicians should evaluate for underlying conditions like diabetes that could explain both symptoms, or consider the possibility of separate and unrelated pathologies.