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The microflora of the vagina, along with other factors, determines the colonization resistance of the vagina. As you know, in the vaginal microcenosis includes more than 40 species of microorganisms, which are 93-97% H2O2-producing lactobacilli.
About 20% of nonpregnant women of reproductive age are determined by yeast-like fungi Sandida related to opportunistic pathogens, the realization of the pathogenic properties of which occurs in the presence of exogenous and / or exogenous risk factors. Mushrooms of the genus Candida includes more than 170 species, among which C.albicans has the greatest value in causing the disease. Its natural habitat is in the human body - the mouth, intestines, reproductive organs. It is believed that C.albicans is the causative agent of candidiasis in 75-80% of cases. However, over the past 10 years has been a clear trend of increasing prevalence of vulvovaginal candidiasis caused by C. "non-albicans╩ species. More common S.glabrata, C.tropicalis, C.parapsilosis, C.krusei and others that are associated with chronic forms of the disease and difficult treatment. Risk factors vulvaginalnogo candidiasis include: ● Physiological - Pregnancy
● Mechanical - intrauterine devices (especially her wearing long), the first sexual intercourse, tight synthetic clothing;
● Endocrine - diabetes, thyroid disease, the absolute or relative giperestrogenemiya;
● iatrogenic - antibiotics, corticosteroids, immunosuppressive medication, oral contraceptives;
● immunodeficiency;
● infections, sexually transmitted diseases. Vulvovaginal candidiasis is characterized by the following clinical symptoms:
● thick white cheesy discharge;
● itching of the vulva and vagina;
● hyperemia and edema of the mucosa of the vulva and vagina. By the nature of the disease are the following clinical forms:
● kandidonositelstvo;
● acute vulvovaginal candidiasis;
● chronic recurrent vulvovaginal candidiasis. Treatment of vulvovaginal candidiasis Vulvovaginal candidiasis therapy 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 vulvovaginal candidiasis:
● should seek to maximize the total 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 vulvovaginal candidiasis:
● treatment with anti-TB drugs;
● preventive therapy (to prevent recurrence of the disease). Local therapy The advantage of local products is that they are practically not absorbed, creating a high concentration of antimycotics on the mucous membrane, provide a rapid decrease in clinical symptoms. Therefore, their use is justified in pregnancy and lactation. The disadvantage of local therapy is the uneven distribution of the drug on the surface of the mucous membrane, which creates conditions for the preservation of the reservoir of infection. In the appointment of topical antimycotics is not ensured elimination of systemic candida infection in the other tanks, which can lead to recurrence of infection. Many patients point to the inconvenience of use, which reduces the quality of life. These failures of local resources determine the relevance of systemic therapy. Systemic therapy The advantage of systemic antimycotics is the high efficiency of treatment, the distribution in many organs and tissues, and thus - the impact on the agent in any location. One important advantage of systemic antimycotics is easy to use compared to local vaginal 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 C.glabrata is dose-dependent to fluconazole, and only if it is applied at a dose of 400-800 mg per day is possible elimination of the pathogen.  So, if you hold the culture diagnosis is not possible, treatment should be antimycotics widest possible range of actions - itraconazole (Mikotroksom). In addition to broad-spectrum, highly lipophilic Mikotroks 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 vulvovaginal 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. Scheme of treatment of acute vulvovaginal 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 vulvovaginal 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 vulvovaginal 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. We observed 26 patients with vulvovaginal candidiasis: in 9 of them are diagnosed with acute, 17 - chronic relapsing. The most common cause of acute candidiasis - this antibiotic (6 patients), in 2 patients candidiasis was triggered by the use of oral contraceptives and in one patient the cause was not possible. The diagnosis of chronic vulvovaginal candidiasis is established, provided that a woman has four or more relapses within one year. All patients in this group periodically received topical and systemic therapy with antimycotics various short-term effect. Bacteriological examination of 23 patients identified C.albicans, in 2 - C.tropicalis, in one - C.crusei. Patients with acute vulvovaginal candidiasis Mikotroks administered 200 mg 2 times daily for 1 day for chronic relapsing - 200 mg 1 time a day, 7 days (main course), to prevent a recurrence - 200 mg once a day once the first day periods of 4-6 months. All patients tolerated the therapy well. Clinical manifestations of the disease resolved within the first two days in all patients with acute candidiasis, and 7 - chronic. The remaining 10 patients recovery occurred by the end of primary treatment. Against the background of preventive therapy for relapse in 11 patients not recorded, 6 were mild and resolved on their own. Thus, studies have shown a high efficacy and good tolerability of systemic antimycotics in the treatment of Mikotroksa various forms of vulvovaginal candidiasis. Ease of use and lack of side effects makes it possible to recommend Mikotroks not only for treatment but for prevention of recurrent vulvovaginal candidiasis. A special group with chronic recurrent candidiasis of the mucous urogenital form patients on prolonged antibiotic therapy against chronic infections, sexually transmitted infections (STIs). Frequently (up to 10% of cases) in such patients have to conduct repeated courses of antibiotic therapy. This fact and determines the presence of candidiasis. Determine the most effective and safe tactics against fungal pathogens in the treatment of STIs is an important issue. To work out methods of use of antifungal drugs in the treatment of STIs has been formed group of patients (14 women) with symptomatic vaginal candidiasis. Antibiotic therapy was carried out on the urogenital chlamydiosis in 9, mycoplasmosis in 5 patients. Number of prior courses of antibiotic therapy was as follows: 2nd year - in 3, 3 - in 3, 4 - in 7, 5 - in 1. Duration of recurrent vaginal candidiasis ranged from 5 months to 4 years. The previous antimycotic therapy consisted of a single dose of medication fluconazole 150 mg in 8 patients, a combination of local treatments and drugs nystatin at 6. Recurrences of candidiasis were observed in all patients after completion of antimycotic therapy.  Based on data from foreign publications about the need for prolonged therapy of anti-candida, we carried out a determination of clinical efficacy "Difloks" (fluconazole) in the treatment of recurrent urogenital candidiasis. 5 patients received "Difloks" 150 mg 1 time in 7 days for combined therapy of STIs and controls during the period of cure, which amounted to eight devices. 9 - to symptomatic candidiasis received the drug at a daily dose of 50 mg once daily for the entire course of antibiotic therapy, which amounted to 28 ot14 days of admission. Symptoms of urogenital candidiasis regressed in all 14 patients, despite ongoing antibiotic therapy, already on day 2 of treatment and did not recur during the period of controls cure. Application of this technique avoids poliprogmazii in the treatment of STIs, and to achieve good results of the clinical and microbiological cure patients, it is especially important for those patients in whom treatment of STIs is a step in preparation for reconstructive operations on the genitals and the methods of in vitro fertilization. As you know, pregnant fungal infections are dangerous because of high risk infants: more than 10% of children born to mothers with vaginal candidiasis, fungal lesions are detected. Long-term antifungal therapy drug azole-origin "Difloks" is a highly effective and safe treatment for recurrent and persistent mucosal candidiasis. Struggle with recurrent vulvovaginal candidiasis also include the correction of predisposing factors, chronic infections and other diseases, diabetes, disorders of immunity. We recommend the use of vitamin complexes containing biotin. Keep in mind that art is a doctor, among other things, and the ability to explain the reasons for a woman of her disease and the basic principles of treatment. Necessary to reassure the patient, and in case of psychological or other problems associated with her illness, to organize consultations with relevant experts. EA Levonchuk, IG Shimanskaya Recipe № 3, 2007
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