The sexual transmission of genitourinary candidiasis: Myths and Realities

Among patients and even some doctors are of the opinion that the urogenital candidiasis is an infection transmitted sexually, as is often the emergence and exacerbation of the disease is associated with sexual intercourse. Based on literature data and our own observations we wanted to see how this view is justified.

Men most often affected the foreskin of the penis. Among men suffering from urogenital candidiasis in 96.6% and balanoposthitis was only 3.4% - urethritis (1). I. Moors (1) found Candida albicans in 8.7% of patients complicated postgonoreynym urethritis (prostatitis, epididymitis, vesiculitis).

In this yeast-like fungi are often isolated from the urethra, prostate gland secretion in association with other microorganisms that live in the urethra or fall in the urinary tract from the outside.

The pathogenesis of urogenital candidiasis complicated and depends on many exogenous and endogenous factors. By the genitourinary candidiasis predispose long-term treatment with antibiotics, corticosteroids and cytotoxic drugs, catheterization, trauma of the mucous membrane of the urinary tract, length of hospital stay after burns and surgical operations. In the development of the disease play a role diabetes and other endocrine diseases, abuse of food rich in carbohydrates.

In 82% of women with urogenital candidiasis, revealed inflammatory, neoplastic and endocrine diseases of urogenital organs, including ovarian dysfunction - a 16% primary infertility - 5%, ovarian hypofunction - 2% (1).

Yeast-like fungi isolated from the urinary tract, have a strong sensitizing effect. Sensitizing and allergenic properties of fungi can cause a variety of pathological changes in the mucous membranes, aided by their trauma, maceration, prolonged presence of inflammatory processes, reducing the body's defenses. As a result, formation of pathogenic strains of yeast fungi of hydrolytic enzymes and toxins, urinary tract lesions caused by them, flowing long and difficult to treat (2, 4).

So far, no single point of view about the transmission of vulvovaginal candidiasis (IHC). Is vulvovaginal candidiasis an endogenous infection or exogenous infection occurs? Until now, these questions are the subject of debate.

There is a view that 30-40% of vulvovaginal candidiasis is associated with sexual transmission. However, only 5-25% of sexual partners of women with VC detect carriers of fungi. At the same titer colonization of the skin of the penis head is most often low and not sufficient to infect the vagina. Therefore, the probability of sexual transmission of the VC does not exceed 25-30%.

We also know that Candida urinary tract in women occurs 10 times more often than men. Many women who suffer recurrent IHC do not live sexual life. In addition, against the values ​​of the sexual transmission of the IHC demonstrates the low efficiency of treatment of sexual partners in the prevention of recurrence of his (2).

Routine screening and treatment of sexual partner (s) sick woman with vulvovaginal candidiasis is permitted, but not always done and is not always necessary (5). Importance of sexual transmission is low at the IHC, although the possibility of sexual contact with a woman prone to man is not denied.

Promiscuity is not accompanied by an increased frequency of colonization or infection. Nevertheless, the elimination of Candida spp. in the oral cavity and the mucosa of the penis partner (after oral-genital contact) leads to a lower relapse rate (3).

Reinfection mushrooms from other foci of endogenous infection (colon, endometrium), not the cause of recurrent vulvovaginal candidiasis. Therefore, to treat a possible source of reinfection in the gut with oral antimycotic means of local action is inappropriate. Widely used in medical practice, the elimination of intestinal dysbiosis in the GDI by eubiotics lacked a scientific basis (3).

Correction of the immunological status of each case should be individualized and based on data immunograms patients, but not be of a general recommendation.

We set ourselves the task to find out how often candidiasis is an infection transmitted sexually, and how justified prophylactic treatment of sexual partners.

We observed 23 women with recurrent vulvovaginal candidiasis and 14 men with urogenital candidiasis. In a study of sexual partners of women with candidiasis revealed that the clinical manifestations of balanoposthitis after sexual intercourse at the time of acute candidiasis in women registered in 5 male partners (21.7%), Candida fungi in the smears from the urethra without clinical symptoms of urethritis - in 3 ( 13%).

Urogenital candidiasis in all men was manifested in the form of balanoposthitis and only one patient had clinical symptoms of urethritis, although in smears from the urethra yeast found in 5 (35.7%) patients. In 10 (71.4%) patients the disease recurred after sexual intercourse with regular partners, have identified two diabetes has two probable causes of recurrence were dietary or hygienic error. In 13 patients with female sexual partners of men in the discharge of genital Candida were found, but clinical symptoms of vulvovaginitis occurred in 5 (35.7%) were women, and 8 (57.1%) diagnosed kandidanositelstvo.

Therapy of urogenital candidiasis should be comprehensive, phased, include not only etiotropic treatment, but also the elimination of predisposing factors, and treatment of opportunistic diseases.

General provisions in the treatment of candidiasis:
∙ The need to seek the fullest possible elimination of the pathogen;
∙ dosage and duration of treatment depends on the clinical course and evaluate the effectiveness of the therapy.
Basic principles of treatment of candidiasis:
∙ therapy with antifungal drugs;
∙ preventive therapy (to prevent recurrence of the disease).
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Systemic therapy
The advantage of systemic antimycotics is the high efficiency of treatment, the distribution of many organs and tissues, as well as being easy to use compared to local forms.

Taking into account the growth of Candida resistance to antimycotics, currently systemic candidiasis therapy should be administered, taking into account the sensitivity of the pathogen. For example, C.krusei genetically resistant to fluconazole, and is dose-dependent C.glabrata of fluconazole, and only if it is applied at a dose of 400-800 mg per day is possible elimination of the pathogen. Therefore, if The culture diagnosis is not possible, treatment should be antimycotics widest possible range of actions - itraconazole (Mikotroksom). In addition to broad-spectrum Mikotroks highly lipophilic, and therefore retained in tissues after administration of the drug for 3 days, ensuring elimitnatsiyu pathogen.

An extremely common mistake is to assign for the treatment of urogenital candidiasis polyene antimycotics - nystatin, levorin, natamycin as a "systemic" drugs. Their bioavailability is less than 5%, so the outside of the gastrointestinal tract, these antimycotics ineffective.

Treatment regimens of acute urogenital candidiasis systemic antimycotics:
∙ itraconazole (Mikotroks) 200 mg 2 times daily for 1 day or 200 mg once daily for 3 days;
∙ Fluconazole (Difloks) 150 mg orally once.
Systemic antimycotics for the treatment of chronic urogenital candidiasis (main course):
∙ itraconazole (Mikotroks) 200 mg 1 time per day 3-7 days;
∙ Fluconazole (Difloks) 150 mg 3 times at intervals of 72 hours
∙ ketoconazole 200 mg 2 times a day, 5 days.
Prevention of relapse of chronic recurrent urogenital candidiasis:
∙ itraconazole (Mikotroks) 200 mg once a day once in a day of menstruation of 4-6 months;
∙ Fluconazole (Difloks) 100-150 1 mg once a week, 6 months, then on day 1 of menstruation 6 months;
∙ ketoconazole 100 mg 1 time per week 6 months.
In patients with recurrent urogenital candidiasis preference system antimycotics (Mikotroks, Difloks), especially in the defeat of two or more lesions, detection of Candida in the urethra. The duration of the basic course of 3-7 days. To prevent a recurrence of systemic antimycotics prescribed for 4-6 months in accordance with the scheme shown above.
Sexual partners of female patients received systemic antimycotic therapy only when it detects them in the discharge of Candida urinary tract, however, even their long-term treatment of anti-did not prevent relapse. In contrast, long-term therapy of anti-sex partners of men with urogenital candidiasis led to sustained remission of the disease in these men.

Based on research carried out by following conclusions:

1. Urogenital candidiasis infection, sexually transmitted occurs predominantly in men and has no practical significance for women.
2. Kandidonositelstvo found in 13% of women with genital Partner of vulvovaginal candidiasis and 92.8% of men with genital parnersh urogenital candidiasis.
3. Systemic antimycotics Mikotroks Difloks and are highly effective for the treatment and prevention of recurrence of urogenital candidiasis in both men and women.
4. Long-term treatment of anti-sex partners effectively with urogenital candidiasis in men and does not prevent the recurrence of the disease in women.