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Candida Vulvovaginitis must be differentiated from the following diseases which have a similar presentation:<ref name=CDC-BV> Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016 </ref><ref name="pmid10839558">{{cite journal| author=Bachmann GA, Nevadunsky NS| title=Diagnosis and treatment of atrophic vaginitis. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 10 | pages= 3090-6 | pmid=10839558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10839558  }} </ref><ref name="pmid2448502">{{cite journal| author=Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB et al.| title=Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. | journal=JAMA | year= 1988 | volume= 259 | issue= 8 | pages= 1223-7 | pmid=2448502 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2448502  }} </ref><ref name="pmid21422855">{{cite journal| author=Sobel JD, Reichman O, Misra D, Yoo W| title=Prognosis and treatment of desquamative inflammatory vaginitis. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 4 | pages= 850-5 | pmid=21422855 | doi=10.1097/AOG.0b013e3182117c9e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422855  }} </ref><ref name="pmid97946645">{{cite journal| author=Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK| title=Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. | journal=Obstet Gynecol | year= 1998 | volume= 92 | issue= 5 | pages= 757-65 | pmid=9794664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9794664  }}</ref>
Candida Vulvovaginitis must be differentiated from the following diseases which have a similar presentation:<ref name=CDC-BV> Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016 </ref><ref name="pmid10839558">{{cite journal| author=Bachmann GA, Nevadunsky NS| title=Diagnosis and treatment of atrophic vaginitis. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 10 | pages= 3090-6 | pmid=10839558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10839558  }} </ref><ref name="pmid2448502">{{cite journal| author=Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB et al.| title=Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. | journal=JAMA | year= 1988 | volume= 259 | issue= 8 | pages= 1223-7 | pmid=2448502 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2448502  }} </ref><ref name="pmid21422855">{{cite journal| author=Sobel JD, Reichman O, Misra D, Yoo W| title=Prognosis and treatment of desquamative inflammatory vaginitis. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 4 | pages= 850-5 | pmid=21422855 | doi=10.1097/AOG.0b013e3182117c9e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422855  }} </ref><ref name="pmid97946645">{{cite journal| author=Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK| title=Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. | journal=Obstet Gynecol | year= 1998 | volume= 92 | issue= 5 | pages= 757-65 | pmid=9794664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9794664  }}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
==Epidemiology and Demographics==
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Trichomoniasis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with purulent, malodorous, thin discharge associated with burning, [[pruritus]], and [[dysuria]], with the signs of vaginal [[inflammation]] and elevated vaginal [[pH]] (>4.5)
*Motile trichomonads on wet mount are demonstrated
*Positive culture (Gold standard)
*Positive nucleic acid amplification test (NAAT)
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Atrophic vaginitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Progressive symptoms 
*Presents with yellow and malodorous vaginal discharge, vaginal dryness, postcoital bleeding, and [[dyspareunia]] with the signs of vaginal [[inflammation]] and elevated vaginal pH (>5)
*Diagnosis is critical and laboratory tests help to confirm hypoestrogenic state
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Desquamative inflammatory vaginitis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chronic clinical syndrome with unknown etiology
*Presents with [[dyspareunia]], dyspareunia, yellow, grey, or green profuse vaginal discharge with the signs of vaginal [[inflammation]] and elevated vaginal pH (>4.5)
*Microscopy shows large number of parabasal (immature squamous epithelial cells) and inflammatory cells
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Bacterial Vaginosis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with [[dysuria]], vaginal discharge
*Fishy odor (positive whiff test)
*Normal vaginal PH (<4.5)
*On speculum examination signs of vaginal inflammation are demonstrated.
|}


==Epidemiology and Demographics==
*Epidemiological studies on [[Candida]] [[vulvovaginitis]] are hard to perform, because of several factors:<ref name="pmid9500475">{{cite journal |vauthors=Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, Reed BD, Summers PR |title=Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations |journal=Am. J. Obstet. Gynecol. |volume=178 |issue=2 |pages=203–11 |year=1998 |pmid=9500475 |doi= |url=}}</ref><ref name="pmid17560449">{{cite journal |vauthors=Sobel JD |title=Vulvovaginal candidosis |journal=Lancet |volume=369 |issue=9577 |pages=1961–71 |year=2007 |pmid=17560449 |doi=10.1016/S0140-6736(07)60917-9 |url=}}</ref>
**[[Candida]] [[vulvovaginitis]] is not a reportable disease.
**The diagnosis of [[Candida]] [[vulvovaginitis]] is based on clinical presentation and positive laboratory findings. Relying on a positive culture alone would likely overestimate the prevalence of [[Candida]] [[vulvovaginitis]].
**The use of over-the-counter (OTC) topical anti-fungals makes it difficult to conduct epidemiological studies.
*Candida is the second most common cause of vaginal infection in young women following [[Bacterial vaginosis|Bacterial Vaginosis]].<ref name="pmid17197596">{{cite journal| author=Allsworth JE, Peipert JF| title=Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. | journal=Obstet Gynecol | year= 2007 | volume= 109 | issue= 1 | pages= 114-20 | pmid=17197596 | doi=10.1097/01.AOG.0000247627.84791.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17197596  }} </ref>
=== Age ===
*[[Incidence]] of Candida vulvovaginitis is higher in pregnant women.<ref name="pmid523355">{{cite journal| author=Hurley R, De Louvois J| title=Candida vaginitis. | journal=Postgrad Med J | year= 1979 | volume= 55 | issue= 647 | pages= 645-7 | pmid=523355 | doi= | pmc=2425644 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=523355  }} </ref><ref name="pmid16784126">{{cite journal| author=García Heredia M, García SD, Copolillo EF, Cora Eliseth M, Barata AD, Vay CA et al.| title=[Prevalence of vaginal candidiasis in pregnant women. Identification of yeasts and susceptibility to antifungal agents]. | journal=Rev Argent Microbiol | year= 2006 | volume= 38 | issue= 1 | pages= 9-12 | pmid=16784126 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16784126  }} </ref>
*Women in reproductive age group are prone for Candida vulvovaginits and at least one episode is reported in 70 to 75% in this population group.<ref name="ZuckermanRomano2016">{{cite journal|last1=Zuckerman|first1=Andrea|last2=Romano|first2=Mary|title=Clinical Recommendation: Vulvovaginitis|journal=Journal of Pediatric and AdolescentGynecology|volume=29|issue=6|year=2016|pages=673–679|issn=10833188|doi=10.1016/j.jpag.2016.08.002}}</ref>
*40 to 50% of patients with a prior yeast infection have multiple episodes of yeast infection.<ref name="pmid523355">{{cite journal| author=Hurley R, De Louvois J| title=Candida vaginitis. | journal=Postgrad Med J | year= 1979 | volume= 55 | issue= 647 | pages= 645-7 | pmid=523355 | doi= | pmc=2425644 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=523355  }} </ref>
*Among the adult population 5 to 8% women have more than four episodes of infection.<ref name="pmid9861594">{{cite journal| author=Foxman B, Marsh JV, Gillespie B, Sobel JD| title=Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey. | journal=J Womens Health | year= 1998 | volume= 7 | issue= 9 | pages= 1167-74 | pmid=9861594 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9861594  }} </ref>
*In 20% asymptomatic healthy [[adolescent]] women, candida species can be isolated from the vagina.<ref name="Barousse2004">{{cite journal|last1=Barousse|first1=M M|title=Vaginal yeast colonisation, prevalence of vaginitis, and associated local immunity in adolescents|journal=Sexually Transmitted Infections|volume=80|issue=1|year=2004|pages=48–53|issn=1368-4973|doi=10.1136/sti.2002.003855}}</ref>
===Race===
Candida vulvovaginitis is more prevalent among African American women than white American women.<ref name="pmid9861594">{{cite journal| author=Foxman B, Marsh JV, Gillespie B, Sobel JD| title=Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey. | journal=J Womens Health | year= 1998 | volume= 7 | issue= 9 | pages= 1167-74 | pmid=9861594 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9861594  }} </ref>
==Risk Factors==
==Risk Factors==
Risk factors for Balanitis include:
Risk factors for Balanitis include:
Line 124: Line 80:


===Complications===
===Complications===
Long-term inflammation or infection can:
* Scar and narrow the opening of the penis (meatal stricture)
* Make it difficult and painful to retract the foreskin to expose the tip of the penis (a condition called phimosis)
* Make it difficult to move the foreskin over the head of the penis (a condition called paraphimosis)
* Affect the blood supply to the tip of the penis
* Increase the risk of penile cancer


==Diagnosis==
==Diagnosis==

Revision as of 18:57, 16 January 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Synonyms and keywords: balanoposthitis

Overview

Historical Perspective

Classification

Pathophysiology

Infectious

Non-infectious

Causes

Causes of Balanitis include the following:

  1. Candidal balanitis
  2. Anaerobic balanitis
  3. Aerobic balanitis
  4. Lichen sclerosus
  5. Lichen planus
  6. Zoon’s (plasma cell) balanitis
  7. Psoriasis and circinate balanitis
  8. Eczema (including irritant, allergic and seborrhoeic)
  9. Non-specific balanoposthitis
  10. Fixed drug eruptions

Premalignant conditions:

  1. Erythroplasia of Queyrat
  2. Bowen’s disease
  3. Bowenoid papulosis

Miscellaneous

Stevens-Johnson syndrome

Differentiating Candida Vulvovaginitis from other Diseases

Candida Vulvovaginitis must be differentiated from the following diseases which have a similar presentation:[1][2][3][4][5]

Epidemiology and Demographics

Risk Factors

Risk factors for Balanitis include:

  • Uncircumcised penis
  • Antibiotic use
  • Corticosteroid use
  • Immunocompromised
  • Diabetes
  • Not usually considered sexually transmitted

Screening

There are no screening procedures for Balanitis.

Natural History, Complications and Prognosis

Natural History

Prognosis

Complications

Long-term inflammation or infection can:

  • Scar and narrow the opening of the penis (meatal stricture)
  • Make it difficult and painful to retract the foreskin to expose the tip of the penis (a condition called phimosis)
  • Make it difficult to move the foreskin over the head of the penis (a condition called paraphimosis)
  • Affect the blood supply to the tip of the penis
  • Increase the risk of penile cancer

Diagnosis

History and Symptoms

Symptoms include:

  • Redness of foreskin or penis
  • Other rashes on the head of the penis
  • Foul-smelling discharge
  • Painful penis and foreskin

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Surgical Therapy

Prevention

Primary Prevention

Secondary Prevention

References

  1. ↑ Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016
  2. ↑ Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
  3. ↑ Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB; et al. (1988). "Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens". JAMA. 259 (8): 1223–7. PMID 2448502.
  4. ↑ Sobel JD, Reichman O, Misra D, Yoo W (2011). "Prognosis and treatment of desquamative inflammatory vaginitis". Obstet Gynecol. 117 (4): 850–5. doi:10.1097/AOG.0b013e3182117c9e. PMID 21422855.
  5. ↑ Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK (1998). "Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm". Obstet Gynecol. 92 (5): 757–65. PMID 9794664.
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