What is a genital mycotic infection?

Genital Mycotic Infections

A genital mycotic infection is a fungal infection affecting the genital area, most commonly caused by Candida species, with Candida albicans being the predominant pathogen. These infections manifest as vulvovaginal candidiasis in women and Candida balanitis in men (primarily in uncircumcised individuals) 1.

Clinical Presentation

In Women (Vulvovaginal Candidiasis)

• Primary symptoms:
  • Intense vaginal and vulvar itching
  • White, thick, "cottage cheese-like" discharge
  • Minimal or no odor
  • Normal vaginal pH (≤4.5)
  • Vulvovaginal irritation
  • Dyspareunia (painful intercourse)
  • External dysuria 2, 3

In Men (Candida Balanitis)

• Primarily affects uncircumcised men
• Presents with inflammation of the glans penis
• May have white patches or discharge
• Itching and irritation 1

Causative Organisms

• Candida albicans: Most common cause (90% of cases) 4
• Non-albicans species: Increasingly prevalent, especially in recurrent cases
  • C. glabrata (particularly common in women with type 2 diabetes)
  • C. tropicalis
  • C. krusei
  • C. parapsilosis 5, 1, 6

Risk Factors

1. Diabetes mellitus: Particularly with poor glycemic control 1
2. Antibiotic use: Disrupts normal vaginal flora 3
3. Pregnancy: Incidence increases to 30% (vs. 10% in non-pregnant women) 4
4. Hormonal contraceptives: Alters vaginal environment 4
5. Immunosuppression: Including HIV infection 2, 6
6. Other factors:
   • Corticosteroid use
   • Atopy
   • Genetic predisposition (in women)
   • Certain sexual behaviors (e.g., orogenital sex) 1

Diagnosis

Clinical Evaluation

• Characteristic symptoms and appearance of discharge
• Vaginal pH measurement (typically ≤4.5 in candidiasis) 3

Laboratory Confirmation

• Microscopy:
  • Saline wet mount
  • 10% KOH preparation (improves visualization of yeast and pseudohyphae) 2, 3
• Culture: Gold standard for diagnosis and species identification 3, 4
• Other tests: Immunologic examinations may be used 4

Treatment

Uncomplicated Vulvovaginal Candidiasis

• Topical azoles: (First-line)
  • Clotrimazole
  • Miconazole
  • Butoconazole
  • Applied intravaginally for 1-7 days depending on formulation 2, 3
• Oral therapy:
  • Fluconazole 150 mg single oral dose 3, 7

Complicated/Recurrent Cases

• Longer duration of therapy (7-14 days)
• May require maintenance therapy
• Consider non-albicans species with potential azole resistance 5
• For resistant strains: Consider polyenes (nystatin, amphotericin B) or ciclopirox 7

Candida Balanitis

• Topical antifungal creams applied directly to affected areas
• Improved hygiene for uncircumcised men
• Treatment of sexual partners if similarly infected 1

Special Considerations

Diabetes

• Establishing and maintaining euglycemia is crucial for both treatment and prevention of recurrence
• Patients with diabetes are more prone to non-albicans species infections that may be less responsive to conventional treatments 1

Pregnancy

• Safe treatment options include clotrimazole cream (first trimester)
• Metronidazole oral or gel, or clindamycin cream (second and third trimesters) 3

HIV Infection

• Patients with HIV should receive standard antifungal treatment
• May experience more frequent or severe infections 2

Prevention

• Glycemic control: Essential for diabetic patients 1
• Probiotics: Show promising results in prevention and as adjunctive therapy 3
• Hygiene measures:
  • Daily lukewarm baths (30 minutes) to remove discharge and debris
  • Mild antiseptic baths for recurrent infections 3
• Avoid unnecessary antibiotic use
• Vaccine development: Advanced approach under investigation 6

Follow-up

• Generally not necessary if symptoms resolve
• Return visit recommended if symptoms persist or recur
• Follow-up evaluation one month after treatment completion is recommended for pregnant women 3

Genital mycotic infections, while common, can significantly impact quality of life. Proper diagnosis, identification of the causative species, and appropriate treatment based on clinical presentation are essential for effective management.