Vaginal Candidiasis and HIV Disease
Vaginal candidiasis is a fungal or yeast infection of the vulva and/or vagina. It causes a smelly, thick, white-yellow discharge that might be accompanied by itching, burning and swelling. It can also can make walking, urinating or sex very painful.
Vaginal candidiasis can be an occasional problem for even the healthiest woman. However, it's more common and severe in women with weakened immune systems. For many, a repeating or worsening vaginal yeast infection is the first symptom of HIV infection. This infection can occur at any CD4 count but is likely to occur more often when your CD4 count falls below 100.
Vaginal candidiasis is caused by the fungus called Candida. Everyone has small amounts of the fungus in the mouth, vagina, digestive tract and skin. In healthy persons, their immune systems prevent it from causing infection. However, a weakened immune system can allow the Candida to grow and cause disease.
Certain drugs can alter the natural organisms in the vagina, which can then allow the Candida to grow. These include the extended use of antibiotics, steroids and oral contraceptives (birth control) with a high estrogen content. Other factors that may cause candidiasis include diabetes, pregnancy, using antihistamines and iron, folate, vitamin B12 or zinc deficiency. Cancer chemotherapy, stress and depression can also contribute to the disease. Tight fitting pants and reactions to the chemicals in soaps and detergents can lead to vaginal candidiasis as well.
Vaginal candidiasis is usually diagnosed by appearance and symptoms. Because symptoms are similar to many other conditions, like the sexual infection trichomonas, your doctor should confirm a diagnosis by scraping the affected area for examination under a microscope.
Topical treatments (applied on the affected area) are the first choices for yeast infections and these generally work for mild-to-moderate cases. These include vaginal creams, suppositories or tablets. Many are available over the counter.
Most topical treatments last only a few days. Longer courses (7-14 days) may be more effective in HIV-positive women.
Generally, topical treatments do not cause side effects, but in a few women they may lead to vaginal burning, itching or skin rash, or even cramps or headaches. Oil-based vaginal creams may weaken latex condoms and diaphragms.
If topical treatment does not work, or if outbreaks recur often, you may need oral drugs. A single oral dose of Diflucan (fluconazole) is increasingly used to treat vaginal candidiasis.
Antifungal Drugs and Pregnancy
The Federal Guidelines for the Prevention of Opportunistic Infections recommend not using antifungal drugs during pregnancy due to possible birth defects. They further state that azoles be stopped in women who become pregnant and that women taking these drugs use effective birth control.
Topical therapies may be preferable for pregnant women. For systemic treatment the Guidelines suggest using AmB, especially in the first trimester.
Although no formal studies have been done, pregnant women have used amphotericin B without apparent harm to their unborn children, though the drug has possible severe side effects including kidney toxicity and anemia.
Using antifungal drugs to prevent fungal infections is approached with great caution and is generally discouraged, especially using fluconazole this way. This makes treating newer and more aggressive infections more difficult and often unsuccessful. However, this may not be possible in some people with recurrent infections who must remain on long-term therapy to prevent them.
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