Is Candidiasis a Common Health Concern for Everyone?

Even though certain types of fungi that can lead to candidiasis naturally exist on the skin and mucous membranes of approximately 50% of individuals, not everyone who carries them will actually develop the illness.

Nonetheless, candidiasis is a prevalent condition that can result in significant discomfort and isn’t always straightforward to treat. To prevent complications, it’s crucial to promptly seek medical advice when you experience unpleasant symptoms.

What is candidiasis?

Candidiasis is an infection caused by microscopic yeast fungi of the genus Candida. In nature, there are more than 160 species of these fungi, but only 20 of them cause candidiasis in humans. Candida albicans is often associated with this infection.

Candidiasis is an infection triggered by tiny yeast fungi belonging to the Candida genus. In the natural world, there are over 160 species of these fungi, but only around 20 of them have been known to affect humans, causing candidiasis. One commonly encountered species in this context is Candida albicans.

How Candida Develops:

Under normal circumstances, the immune system acts as a vigilant guardian, keeping the growth of yeast fungi in check. As long as the immune system is functioning properly, these fungi coexist on the skin, mucous membranes, and within the gastrointestinal and urogenital tracts of many individuals without causing harm.

However, there are instances when these fungi start proliferating rapidly. This can occur during severe illnesses, when the immune system’s control over yeast fungi weakens, or as a result of prolonged antibiotic use, which reduces the population of beneficial microorganisms that normally compete with the fungi.

During such episodes, the fungi attach themselves to the surface of host cells and release enzymes that aid in the absorption of nutrients from the intercellular spaces and the cells themselves. In defense, the immune system produces cytokines—defense substances that not only combat the fungi but also induce inflammation in the affected tissues. If the immune system successfully curtails the overgrowth of yeast fungi, the infection can subside on its own. However, if the immune system is compromised, medical intervention may be necessary for recovery.

What Is Candidiasis Like:

The severity of a yeast infection, known as candidiasis, largely hinges on an individual’s immune system.

For those with significantly compromised immune systems, such as individuals with untreated HIV, recent organ transplant recipients, or those undergoing chemotherapy, a more dangerous form of candidiasis, called invasive candidiasis, can develop. Invasive candidiasis occurs when yeast fungi enter the bloodstream, spreading throughout the body. They can infiltrate the eyes, joints, heart, lungs, and other organs, potentially causing serious damage and, in some cases, leading to a person’s demise.

However, for the majority of people without severe health issues, their immune systems usually prevent the fungi from breaching the bloodstream. Instead, they experience localized infections on the skin and mucous membranes. Fungi may take up residence in skin folds, between the toes, under the nails, or on the mucous membranes of the mouth or genitals but generally do not penetrate deep into the body.

One of the most common forms of candidiasis is localized skin and mucous membrane infections of the genitals, often referred to as thrush. It’s worth noting that thrush is not considered a sexually transmitted infection, as it can occur in individuals who do not engage in sexual activity. However, if someone without thrush engages in unprotected oral, vaginal, or anal sex with a partner who has the infection, they are also at risk of contracting it.

In contrast to invasive candidiasis, thrush does not inflict damage on organs and is not life-threatening. Nevertheless, it can be uncomfortable and may recur, which we will discuss in more detail shortly.

Who Can Get a Yeast Infection:

Yeast infections can affect individuals of any gender. When Candidal infection occurs on the skin and mucous membranes in the genital area of women, it’s referred to as vulvovaginal candidiasis. In men, the same condition is known as candidal balanitis.

However, it’s worth noting that candidal infections of the genital organs are more commonly observed in women than in men. Statistics reveal that at least 75% of women will experience this condition at least once in their lifetime.

There are several risk factors associated with vulvovaginal candidiasis in women. While some cases may occur without clear external causes, certain factors can increase the likelihood of infection. Among these factors, the most prevalent ones include:

1. Broad-Spectrum Antibiotics: The use of broad-spectrum antibiotics is a common contributing factor, as Candida vulvovaginitis develops in 25-33% of women due to antibiotic use.
2. Diabetes Mellitus: Women who have difficulty managing their blood glucose levels with medication are more susceptible to the disease.
3. Immunodeficiency: Women living with HIV infection or taking immune-suppressing drugs like glucocorticoids are at a higher risk compared to those without these conditions.
4. High Estrogen Levels: Pregnant women and postmenopausal women taking estrogen-based medications are more susceptible to the disease compared to non-pregnant women of reproductive age.
5. Genetic Characteristics: Some women with genetic variations in the SIGLEC 15 and TLR2 genes, which encode proteins involved in cell membrane structure, have a higher incidence of Candida vulvovaginitis compared to women with typical gene structures.

Furthermore, experts from the American Office of Women’s Health highlight two additional factors that can increase the risk of developing Candida vulvovaginitis:

1. Clothing Choices: Making incorrect clothing choices can contribute to the development of candidal vulvovaginitis. Synthetic underwear and tight-fitting clothes can elevate body temperature and moisture levels in the genital area. Given that yeast fungi from the Candida genus thrive in warm and moist conditions, it is advisable to opt for breathable cotton underwear and looser-fitting clothing to help prevent candidal vulvovaginitis.
2. Hygiene Practices: Improper hygiene practices in the genital area can also heighten the risk of developing the disease. Actions such as infrequently changing pads and tampons, douching (a procedure that removes normal bacteria from the vagina), and wiping the perineal area from the anus towards the vagina can introduce fungi from the rectum to the mucous membranes.

Regarding candidal balanitis in men, similar to women, there are shared risk factors, including the extended use of antibiotics, immunodeficiency, and diabetes. However, there are also unique risk factors specific to men:

1. Excess Weight: Excess body weight and poor personal hygiene are among the distinctive risk factors. Consequently, some experts suggest that men who have not undergone circumcision might be at a higher risk of developing candidal balanitis compared to those who have had the procedure.

Symptoms of Thrush:

In Women: Women experiencing vulvovaginal candidiasis typically report the following symptoms:

• Itching, burning, or irritation in the vulva and vaginal area.
• Pain, often during sexual intercourse, with itching and discomfort potentially worsening.
• Swelling of the genital area, along with reddening of the mucous membranes.
• Some women may notice a thick, white, cottage cheese-like vaginal discharge that lacks an unpleasant odor and adheres to the vaginal walls. However, discharge may also be absent or minimal.

In Men: Men with candidal balanitis commonly experience these symptoms:

• Inflammation, pain, and irritation in the region of the glans penis (the head of the penis).
• The presence of thick, white, lumpy discharge between the penis and the foreskin.
• Pain during urination and difficulty retracting the foreskin might also be reported by some men.

Diagnosis of Thrush:

The diagnosis of candidal skin and mucous infections of the genitals is similar for both women and men. In either case, a gynecologist or urologist typically makes a diagnosis through the following methods:

1. External Examination: The healthcare provider examines the external skin of the genital area.
2. Analysis of Discharge Sample: A sample of the discharge may be collected for further examination.

The easiest and quickest diagnostic method involves microscopic examination, where a specialist examines a stained sample under a microscope to look for the presence of fungi. However, this method may not always provide the most accurate results as yeast fungi may not always be captured within the microscope’s field of view.

A more precise diagnostic approach is through cultivation. In this method, the sample is cultured on a nutrient medium, allowing the type of fungus to be determined based on what grows. However, this approach takes time, as fungi can take up to 7 days to grow, requiring patients to wait for the results.

In clinical practice, many healthcare providers prefer rapid and accurate Polymerase Chain Reaction (PCR) tests. PCR tests detect the genetic material, such as DNA or RNA, of the pathogen in the sample. These tests are known for their speed and accuracy.

It’s important to note that microscopic examination and culturing of biological material samples, as requested by the doctor, are often covered by healthcare policies. However, since not all government laboratories have the necessary equipment and reagents for PCR testing, individuals may need to seek these tests at private laboratories for a fee.

Tests Prescribed When Suspecting a Yeast Infection:

The specific tests a doctor prescribes when suspecting a yeast infection can vary based on the diagnostic hypothesis and clinical presentation. Here are the typical tests that may be recommended:

1. PCR Test for Candida albicans: If the doctor suspects a typical fungal infection like candidiasis, they may prescribe a laboratory PCR test on a smear to determine the presence of Candida albicans DNA.
2. Basic STI Tests: Since sexually transmitted infections (STIs) can sometimes present with similar symptoms to candidiasis, doctors often recommend comprehensive STI testing. These tests typically include PCR tests for gonorrhea, trichomoniasis, chlamydia, and genital mycoplasma, along with blood tests for syphilis, HIV, hepatitis B, and hepatitis C.
3. PCR Test for Atypical Fungi: In cases of recurrent vulvovaginal candidiasis, a PCR test for atypical fungi may be necessary. This panel of tests may include Candida tropicalis, Candida parapsilosis, Candida glabrata, and potentially other pathogens. Recurrent candidiasis is defined as three or more exacerbations in a year.

It’s worth mentioning that there are also home vaginal test systems available that detect antigens related to Candida fungi in women. However, these should not be used as a substitute for professional medical advice. Their accuracy is around 90%, so there is a possibility of false negative results. Even if the test is positive, it does not specify the exact cause of the infection, as many women naturally have yeast in their vagina without any harm. These tests cannot determine the specific yeast type responsible for the infection, making it impossible to confirm the diagnosis and select the appropriate treatment. Therefore, consulting a healthcare provider is essential for a definitive diagnosis and treatment plan.

Treatment of a Yeast Infection:

Treating candidal infections of the genital area in both men and women involves various antifungal medications. Typically, men are prescribed tablets, while women can be prescribed either tablets or local remedies like vaginal suppositories or creams. The effectiveness of tablets and suppositories is generally comparable.

Many over-the-counter “anti-thrush” medications, often based on popular antifungal drugs like fluconazole, are available without a prescription. These medications typically require just one or two doses. However, it’s essential to note that, similar to antibiotics, easy access to antifungal drugs has led to a gradual decrease in their effectiveness against pathogenic fungi. Consequently, over-the-counter remedies may not always provide relief for everyone.

Even for individuals who are confident that their infection is caused by a fungus rather than a sexually transmitted infection (STI), it’s still advisable to consult a doctor before purchasing medication. If a conventional antifungal treatment doesn’t resolve the issue, a specialist can devise an individualized treatment plan to address yeast fungi that have become resistant to antifungal drugs. Seeking professional guidance ensures that the appropriate treatment approach is selected, enhancing the likelihood of successful resolution.