Can Candida Glabrata Vaginal Infection Be Painful?
Yes, Candida glabrata vulvovaginitis is characteristically painful, presenting with burning, itching, vulvar edema, erythema, excoriation, and fissures—symptoms that can cause significant discomfort during intercourse (dyspareunia) and urination (external dysuria). 1, 2
Clinical Pain Manifestations
The pain associated with C. glabrata vulvovaginitis manifests in several distinct ways:
- Burning sensation is a primary symptom that affects both the vulvar and vaginal tissues 1, 2
- Intense itching (pruritus) causes significant discomfort and is one of the hallmark features 1, 3
- Vaginal soreness develops from the inflammatory response to the infection 1
- External dysuria (painful urination) occurs when urine contacts inflamed vulvar tissue 1
- Dyspareunia (painful intercourse) is common and often prompts women to seek medical care 1, 4
Physical Examination Findings That Cause Pain
The visible inflammatory changes directly contribute to the pain experience:
- Vulvar edema and erythema create tissue tension and sensitivity 1, 2
- Excoriation from scratching due to intense itching leads to raw, painful areas 1, 2
- Fissures may develop in severe cases, causing sharp pain particularly during intercourse or urination 1, 2
- White, thick, adherent vaginal discharge accompanies these painful symptoms 1, 2
Important Clinical Distinctions
C. glabrata vulvovaginitis tends to present with milder but more chronic or recurrent symptoms compared to C. albicans infections, though pain and discomfort are still prominent features 3. This species accounts for 10-20% of recurrent vulvovaginal candidiasis cases and is associated with higher treatment failure rates 1, 5.
Key Diagnostic Pitfall
- Normal vaginal pH (4.0-4.5) should be confirmed—if pH is elevated, consider bacterial vaginosis or trichomoniasis instead 1, 2
- C. glabrata does not form pseudohyphae or hyphae, making microscopic identification difficult; vaginal cultures are essential for definitive diagnosis 1, 2
- Symptoms are nonspecific—pruritus, burning, and discharge can result from multiple infectious and noninfectious etiologies, so confirmation with wet-mount preparation using saline and 10% potassium hydroxide is necessary before treatment 1
Treatment Considerations for Pain Relief
Since C. glabrata is often resistant to standard azole therapy, pain may persist longer than with C. albicans infections:
- Intravaginal boric acid 600 mg daily for 14 days is the recommended first-line treatment for azole-unresponsive C. glabrata vulvovaginitis 1
- Nystatin intravaginal suppositories 100,000 units daily for 14 days serve as an alternative 1
- Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream for 14 days is a third option 1
The longer treatment duration required for C. glabrata (14 days versus 1-3 days for uncomplicated C. albicans infections) means patients may experience painful symptoms for an extended period before resolution 1.