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By Werner Mendling

Fungal infections within the girl play an more and more huge position in daily gynecological perform. this can be the 1st publication to deal comprehensively with vulvovaginal candidosis. Following an creation outlining the prevalence of yeasts in guy, genital colonization within the woman intercourse, yeast in being pregnant and neonatal mycoses, there's a description of the modes of an infection and the identified host reactions, in addition to of the indicators for prognosis and remedy. a few a hundred and fifty colour illustrations depict all identified facultative pathogenetic candida species and different very likely pathogenetic yeasts in natural tradition and below the microscope. medical examples aid clarify the prognosis and differential analysis. the amount presents the health practitioner with convenient, concise and practice-oriented directions to right analysis and powerful remedy of yeasts within the girl patient.

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Example text

Disadvantages of these agents are skin pigmentation, skin intolerance, and, in the case of boric acid which is occasionally used, toxic side effects. The application of these agents only had a curing rate of 60%-70% (Kruschwitz 1976). Hazen and Brown (1950) first isolated the tetraene antibiotic nystatin from Streptomyces noursei. It was the first agent discovered which is effective against yeast fungi and is very compatible; there is practically no intestinal resorption. Thus it became a popular preparation to treat vaginal candidosis and to reduce intestinal yeasts.

Allergic reactions to azoles may also occur and can even cause an anaphylactic shock, but this is extremely rare and is not to be expected with topical use (Raulin and Frosch 1987). In intravaginal treatment with azoles, 3%-10% (-30%) of the active substance applied is resorbed transvaginally, the figure being dependent on the galenical and the active substances (Patzschke et al. 1976; Rindt et al. 1979; Tauber 1981). Due to their rapid metabolism in the liver the effective blood levels of these drugs are so low after vaginal resorption (Ritter et al.

This warrants a closer investigation of vulvitis and vaginitis from a dermatological viewpoint. Meech et al. (1985) succeeded in showing that in cases of hypersensitivity to intradermally administered cytoplasmic Candida antigens, even small numbers of yeast often cause vulvitis, especially after microtrauma (Table 9). Similar factors may apply to the corresponding condition in males (balanitis). According to Monif (1985) diabetics are especially prone to candi- Table 9. 5;;)1 Clinical: Candida albicans: "Thrush" plaques in the vagina Clinical: Acute vulvitis (n=7), normal (n=4) High cell counts Candida albicans Low cell counts (102-1Q4/ml) (> 106 - > 108/ml) Immunological: Reduced T-lymphocyte function, excessive B-lymphocyte reaction 28 "IH"y-p-e-rs-e-=n~siC"'ti-vi""ty--;-(n-=-'-:11"')1 Immunological: Normal B-lymphocyte function, excessive T-lymphocyte reaction.

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