Yeast infections—vaginal | CATIE - Canada's source for HIV and hepatitis C information
While oral thrush is the least serious of the fungal infections associated with HIV, it may indicate that a patient's HIV condition is worsening. Candidiasis (thrush) is a common yeast infection, treated with anti-fungal drugs. Mild candidiasis in the mouth is relatively common in people with HIV. Mucocutaneous candidiasis occurs in 3 forms in persons with HIV infection: although the relationship of vulvovaginal candidiasis to HIV infection remains unclear. (15,16) Oral colonization with inherently drug-resistant organisms is more.
Sugar can appear as glucose, fructose, glucose-fructose and so on. Some manufacturers add juices that are tend to have high levels of naturally occurring sugar such as grape juice to some foods. All of these help to feed yeasts.
It is possible for a man who has sexual contact with an infected partner to develop symptoms, such as itching and a rash on the penis, but this is relatively uncommon. Symptoms A yeast infection can cause the following symptoms: Your doctor will do a pelvic exam—he or she will take a swab of the vagina and have the sample examined under a microscope—to determine whether candida is the cause of the symptoms.
Candidiasis (thrush, yeast infection)
If you do have a yeast infection, try to abstain from sexual activity until the infection has cleared. Otherwise, you might make the vaginal irritation worse and you and your sex partner could re-infect each other. Treatment Fortunately, the symptoms of a yeast infection usually disappear completely with the right treatment.
Treatment for yeast infections include: Local treatments, which treat a particular area affected by the infection Systemic treatments, which treat an infection that affects the whole body Local treatments Many yeast infections can be treated with products you can purchase over-the-counter without a prescription at a drugstore. These include vaginal suppositories a medicine you insert vaginallycreams or lozenges.
The more commonly used drugs include clotrimazole sold under the brand names Canesten and Clotrimaderm and miconazole sold under the brand names Micozole and Monistat. These treatments are relatively inexpensive and cause almost no side effects. However, they can be messy and often take longer to work than systemic treatments. Your doctor will let you know what kind of treatment is suitable for you. Systemic treatments If your yeast infections are more persistent—they do not clear up with local treatment or they keep recurring—your doctor may prescribe a drug pills taken orally that circulates in the bloodstream throughout your body.
They can also cause side effects and interact with other drugs. For many women, an effective systemic treatment for yeast infections is the anti-fungal drug fluconazole Diflucan taken once a day for one to three days. Prevention There are several things you can do to keep the candida that normally lives in our bodies under control.
To avoid getting a yeast infection or to minimize the symptoms of a yeast infection if you already have one, you can also try the following: Cut down on the amount of sugar and starchy foods you eat.
Eat unsweetened yogurt with live bacterial culture Lactobacillus acidophilus. The label of yogurt usually states whether the bacterial cultures are live or active. Supplements of Lactobacillus acidophilus, available at most health food stores, can also help maintain a healthy balance of bacteria in the body and reduce the risk of yeast infections.
Treatment of OPC and vaginal candidiasis is relatively simple, with most types responding to therapy. Overall, randomized studies show little difference between topical and systemic therapy.
Mild OPC or vulvovaginal disease often can be treated with topical therapy. Moderate and severe episodes typically require systemic therapy. Esophagitis always requires systemic therapy. Classes of antifungal agents include polyenes nystatin and amphotericin Bwhich bind to ergosterol in the fungal cell membrane and induce osmotic instability and loss of membrane integrity; azoles, including the imidazoles clotrimazole and triazoles ketoconazole, itraconazole, fluconazole, voriconazole, ravuconazole, and posaconazolewhich inhibit fungal cytochrome Pdependent enzymes, resulting in the impairment of ergosterol biosynthesis and depletion of ergosterol from the fungal cell membrane; pyrimidine synthesis inhibitors, including 5-fluorocytosine flucytosinewhich inhibits DNA and RNA synthesis in fungal organisms; and the echinocandins caspofungin, micafungin and anidulafungincyclic lipopeptides that inhibit beta Nystatin is used in a topical preparation.
The oral form is not absorbed and has minimal side effects other than dysgeusia. Flucytosine is available as a tablet and is associated with such side effects as nausea, vomiting, diarrhea, GI bleeding, renal insufficiency, hepatitis, thrombocytopenia, anemia, and leukopenia. Clotrimazole is available as a spray, solution, and troche for oral use.
Clotrimazole has few side effects, and is absorbed from the GI tract poorly.Hiv Mouth Symptoms with Photos
Ketoconazole is available as a tablet or cream. Achlorhydria has been documented in HIV-infected patients and, when present, may interfere with ketoconazole absorption. The suspension and intravenous formulations have enhanced bioavailability compared with the capsule formulation. Absorption is improved when itraconazole is taken after a meal. Fluconazole, the first triazole compound released in the United States, is absorbed more completely than itraconazole or ketoconazole because absorption is not dependent on gastric acidity or food intake.
Fluconazole is available in suspension, tablet, and parenteral form. In general, the side effects of ketoconazole, itraconazole, fluconazole, posaconazole, and voriconazole are similar, the more common being headache, dyspepsia, diarrhea, nausea, vomiting, hepatitis, and skin rash.
Significant drug interactions with each of these medications are provided in Table 3. The echinocandins are available only in parenteral forms.
Caspofungin and micafungin are approved by the U.
HIV & AIDS Information :: Factsheet Candidiasis (thrush)
Adverse events including fever, nausea, infused-vein complications, and vomiting typically are mild. No treatment trials for vulvovaginal candidiasis in women with HIV infection have been published. Recommendations for the treatment of vulvovaginal disease are made based on data from the non-HIV-infected population. Most of the published controlled trials for the treatment of oral and esophageal candidiasis are listed in Table 4.
There are few significant differences in response rates between topical and systemic therapies or among the different systemic therapies for OPC.
Thus, it is reasonable to conclude that clotrimazole, ketoconazole, fluconazole, and itraconazole probably are equivalent in the acute treatment of most cases of OPC. The treatment of esophageal candidiasis has not been studied so well as the treatment of OPC.
Most experts recommend systemic therapy because of the significant morbidity of esophageal candidiasis and the absence of evidence supporting the use of topical therapy. Response rates to systemic therapies generally are quite good.
Candidiasis (thrush, yeast infection) - POZ
Fluconazole has proved to be more effective than ketoconazole in one trial. Itraconazole solution probably is equivalent to fluconazole for treating esophageal candidiasis.
However, shorter courses have proved effective. Topical therapy for 3 days generally is equivalent to treatment with 7 days of topical medication. Either topical or systemic therapy generally is effective in women with HIV infection, but relapse rates may be quite high.
A likely explanation is that most Candida infections respond to empiric therapy, and in vitro testing for antifungal resistance is not yet as reliable as antibiotic susceptibility testing of bacterial isolates. Some clinical fungal isolates found to be "resistant" by in vitro testing nevertheless respond to therapy. Less commonly, some patients fail to respond to therapy despite having a relatively "sensitive" organism isolated. Thus, despite the determination of standard definitions for what constitutes in vitro resistance, more work must be done in this area before susceptibility testing can be used as a guide to antifungal therapy.
There are a number of newer antifungals in varying phases of clinical development, including triazoles, echinocandins, sordarins, chitin synthase inhibitors, and topoisomerase inhibitors.
Several new agents in the former 2 categories are now approved in the United States. In vitro activity of 3 new triazoles posaconazole, ravuconazole, and voriconazole appears to be quite good for Candida species, the latter agent having been licensed by the FDA in Similarly, posaconazole compared favorably to fluconazole in a dose-ranging study for the treatment of oral candidiasis in HIV infection.
These agents also show promise in the treatment of Candida infections but are limited to parenteral administration at present. Candidiasis refractory to amphotericin B is exceedingly uncommon. The most important step is to determine what medications and dosages have been tried and whether adherence to therapy has been adequate.
Removing any interacting medications or increasing the dose of the antifungal agent may be curative in some persons. In general, persons with OPC that is unresponsive to clotrimazole, nystatin, ketoconazole, or itraconazole tablets will respond to fluconazole.
Persons with OPC unresponsive to fluconazole mg daily given for 2 weeks are less likely to respond to higher doses but sometimes do respond. Additionally, flucytosine may be added for synergy. Options for managing fluconazole-refractory disease are listed in Table 5. There have been few controlled, comparative studies of these approaches. Parenteral amphotericin B or liposomal preparations of amphotericin B remains the drug of choice for persons with severe disease or esophageal involvement.
For mild to moderate fluconazole-refractory OPC, amphotericin B oral suspension, itraconazole solution, or the addition of flucytosine are reasonable therapeutic strategies. Other options for treating fluconazole-resistant isolates include voriconazole, caspofungin, micafungin, and anidulafungin.
Treatment with protease inhibitors has been noted to result in clinical improvement in difficult-to-treat cases. Relapse rates are high in persons with refractory disease, and maintenance suppressive therapy is universally required. Invasive Candidiasis Despite the frequency of mucosal candidiasis, invasive disease is uncommon in persons with HIV infection.
There are few studies describing the incidence and prevalence of nonesophageal invasive candidiasis in HIV-infected persons. Most studies are restricted to case series or anecdotal reports. A retrospective review found the incidence of candidemia to be 0. Candida meningitis remains a rare entity, even among other immunosuppressed patients, and optimal therapy is unknown.
It seems prudent for HIV-infected patients with Candida meningitis to continue chronic suppressive therapy with fluconazole on a regimen similar to that used in the management of cryptococcal meningitis. Prevention The most important method of preventing mucocutaneous candidiasis is reversal of the immunodeficiency associated with HIV infection.