Normal vaginal microflora

Vaginal candidiasis: clinical manifestations and diagnosis

Disruption of the normal state of the vaginal environment often manifests as urogenital candidiasis. Patients report pronounced itching, burning, and the appearance of characteristic curd-like discharge. These symptoms intensify at night, after sexual intercourse, or after water procedures. If the inflammation affects the urinary tract, dysuric disorders join in.

Upon objective examination during the acute period, involvement of the skin of the external genitalia is noticeable: vesicles form, and their rupture leaves erosions. Speculum examination demonstrates edema, hyperemia of the vaginal mucosa and cervix, as well as white or grayish-white curd-like deposits. Colposcopy with Lugol's solution staining visualizes an enhanced vascular pattern and fine-stippled inclusions resembling semolina. In the chronic course, secondary changes predominate: infiltration, atrophy, and tissue sclerosis.

Microbiological examination plays a key role in confirming the diagnosis:

• Smear microscopy (native or Gram-stained) — reveals fungal pseudomycelia and spores.
• Culture method (inoculation on media) — necessary to determine the fungal species and its susceptibility to antimycotics.

Additionally, an assessment of intestinal microbiocenosis, tests for sexually transmitted infections (STIs), and a glucose tolerance test are prescribed.

Comprehensive treatment and restoration of microbiocenosis

Candidiasis therapy is based on a comprehensive approach: targeting the pathogen and eliminating predisposing factors. Discontinuation of oral contraceptives, antibiotics, cytostatics, or glucocorticosteroids is recommended. Medical correction of concomitant diabetes mellitus is mandatory. Condoms must be used during the treatment and observation period.

The treatment regimen depends on the form:

1. Acute forms (1st stage): Local agents (vaginal tablets, suppositories, creams) are used for a course of 6–9 days. Drugs of choice: econazole, isoconazole, clotrimazole, butoconazole, natamycin, ketoconazole, nifuratel.
2. Chronic course: Local treatment is combined with systemic drugs (fluconazole, itraconazole, ketoconazole).
3. Treatment in children: Low-toxicity drugs are used (terconazole/terzhinan, nifuratel, fluconazole). Special applicators that prevent damage to the hymen are used for cream administration.

The most important second stage is the correction of the disturbed vaginal microbiocenosis. Criteria for cure are the complete resolution of symptoms and negative microbiological tests. If ineffective, a repeat course using a different regimen is prescribed.

Trichomonal vaginitis: properties of the pathogen and routes of transmission

A frequent cause of normal flora disruption is the vaginal trichomonad (Trichomonas vaginalis). This is an oval-shaped protozoan microorganism possessing an undulating membrane and 3–5 flagella for motility. It feeds via phagocytosis and endosmosis. Trichomoniasis affects 60–70% of sexually active women, and its contagiousness approaches 100%.

The main route of transmission is sexual. Household transmission (in girls via shared underwear) and intranatal transmission (fetal infection in the birth canal) are not excluded.

In the external environment, the trichomonad is unstable: it dies upon drying, exposure to disinfectants, or heating above 40 °C. The pathogen is often found as part of mixed infections along with gonorrhea, chlamydia, viral infections, yeast-like fungi, and mycoplasmas. Trichomoniasis is considered a mixed protozoan-bacterial infection. Trichomonads can act as a "vehicle", carrying other pathogenic microflora to the upper sections of the reproductive system.

Clinical presentation and consequences of trichomoniasis

The incubation period for trichomoniasis ranges from 3–5 to 30 days. The severity of clinical symptoms depends on the host's immunity and the virulence of the pathogen. In acute and subacute forms, itching, burning, and abundant gray-yellow discharge occur. Their foamy nature is due to symbiosis with concomitant gas-producing bacteria.

The primary focus is the vagina, but involvement of the urethra, cervical canal, bladder, and Bartholin glands is possible. In ascending infection, the trichomonad penetrates through the uterus and fallopian tubes into the abdominal cavity.

Classification by clinical course:

• Fresh (up to 2 months): acute, subacute, or torpid.
• Chronic (more than 2 months): sluggish forms.
• Trichomonas carrier state: the pathogen is present without an inflammatory process.

Trichomonads are capable of reducing sperm motility, which is one of the causes of infertility. Specific immune responses occur in response to invasion, but persistent post-infection immunity does not develop.

Class and exam questions

What else to study on this topic

• The impact of trichomoniasis on reproductive function and the development of infertility.
• Features of vaginal candidiasis therapy in pediatric practice.
• The role of trichomonads as a "vehicle" for other pathogenic microorganisms.
• The culture method of diagnosis and determination of susceptibility to antimycotics.
• Classification of urogenital trichomoniasis by course and presence of complications.

Other topics in the "Gynecology" section

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