Amanda Feemaile came to the clinic with symptoms of vaginal itching, burning, soreness and discharge. She had recently completed an antibiotic treatment for an ear infection. The doctor diagnosed her with vaginal candidiasis, a common yeast infection caused by the fungus Candida albicans. Tests were not required for diagnosis. Amanda was prescribed an anti-fungal cream and instructed on prevention. Vaginal candidiasis occurs when the normal vaginal pH increases, allowing Candida to multiply. Risk factors include antibiotics and hormonal imbalances.
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Brandy Goudreau
Medical Microbiology
Professor Tiffany Martin
October 26, 2016
Vaginal Candidiasis
A 22-year-old patient, named Amanda Feemaile, came to the clinic with some
embarrassing concerns. She stated she has itching, burning, soreness, and a rash in her vaginal
area. Amanda mentioned that she had pain during intercourse and she had small amounts of
whitish-gray vaginal discharge as well. She has recently just completed a course of an antibiotic
to treat an ear infection. To treat Ms. Feemaile, one must first diagnose this disease or infection.
One must understand how and where she got it, the background of what this is specifically, and
how to prevent it from happening again.
Amanda has symptoms that appear to be Vaginal Candidiasis. “This is a common problem in
women, especially of reproductive age and is often misdiagnosed” (Farro 133). To be certain,
doctors will obtain a medical history, question any prior yeast infections and ask about a history
of S.T.I’s. They will perform a pelvic exam and the doctor will examine her vagina and the
surrounding area to check for external signs of infection. They will examine her vaginal walls
and her cervix. Occasionally, a vaginal sample will be sent to the lab for confirmation. Tests are
usually ordered only for women that have yeast infections on a regular basis or for infections that
won’t go away. This is the most accurate way to determine an accurate diagnosis. In Amanda’s
case, they will not need to obtain a vaginal sample at this time.
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The question is, what is Vaginal Candidiasis? This is a vaginal yeast infection. It is a common
female condition. Approximately 75% of women experience at least one in their reproductive
years. “Vaginal Candidiasis represents a serious health problem to women of childbearing
worldwide” (Hamad). Yeast infections are caused by the fungus Candida. “In healthy women with
normally functioning immune systems, infection of mucosal surfaces by Candida is readily treated
and rarely occurs repeatedly” (Gregory). Candida is parasitic fungi that resemble yeasts, occur
especially in the mouth, vagina, and intestinal tract where they are usually benign but can become
pathogenic, and have been grouped with the imperfect fungi, but are now often placed with the
ascomycetes. “Vaginal candidiasis shows itself as white mucoid colonies that grow on the mucous
membrane of the vagina and on the skin that covers the vaginal labia” (Bauman 762). This yeast
causes burning and itching. Urination causes it to get worse. The incubation period is 7-10 days in
most cases. Candidiasis can involve any mucous membrane, but in Amanda’s case, the discussion
will remain with the vaginal area. This needs to be broken down into a smaller piece now.
The species that candidiasis breaks down into is C. albicans. This is the most common
species. It is an ascomycete yeast that takes advantage of its environment. It creates long cellular
extensions called pseudohyphae, which means it appears to be the same as true hyphae of
filamentous fungi. C. albicans is a normal part of the vagina and it tends to compete with
lactobacilli and other bacteria. When the vaginal pH becomes more alkaline than what it is
supposed to, like when taking an antibiotic or a hormonal imbalance, Candida multiplies very
quickly. The normal pH of the vagina should be between 3.8-4.5. With this alkaline environment
it can create inflammation and a “fishy” odor, along with many other symptoms. These are a type
of blastomycetes, which are a class of fungi that form single yeast cells that reproduce by
budding. For example, a new cell is formed by extrusion from the outer limits of the parent cell.
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In some cases, a poorly developed mycelium or branching structure only has one copy of its
chromosome and makes it haploid. It grows by one haploid meeting another and then fusing. The
two fused cells then contain two nuclei and they remain autonomous and function separate from
one another. This fusion happens before spore formation. Several of these duplications and
shuffling of genetic material produces four spores, with each having different genetic identity. At
any time, this network may be actively growing while another region may be dormant, awaiting
better conditions for growth. This is what is occurring at the molecular level. It is rare, but it can
be transferred by sexual intercourse and by vaginal birth. When this is observed closely, stained
preparations of vaginal discharge reveal clusters of budding yeast and branching pseudohyphae.
This is violet or purple when observed as a gram stain. This comes from the first known mention
of it from of Hippocrates from 460–370 BCE. Vulvovaginal candidiasis was first described in
1849 by Wilkinson. In 1875, Haussmann demonstrated the causative organism in both
vulvovaginal and oral candidiasis is the same. With the manufacturing of antibiotics following
World War II, the rates of candidiasis increased. The rates then decreased in the 1950s following
the development of nystatin. The history of candidiasis leads to this present case.
Now that it is known what it looks like under a microscope let’s look at what this means for
the patient. Amanda got Vaginal Candidaisis because she was on an antibiotic for an ear infection
2 weeks prior to her visit. This killed most of the “good bacteria” she had in her body. This gave
room for the fungus to take over. She was treated with a three-day regimen of an anti-fungal
cream called butoconazole. She was also instructed to have her sexual partner to get checked out
and if they were to have intercourse to use a condom. The patient was warned that if she did not
treat this infection it had the possibility to suppress her immune system and make her more
susceptible to other more complicated infections. This could also cause intense pain during
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urination. Additionally, if a woman and her partner are presently attempting to conceive a child,
an untreated yeast infection may make that process difficult. The presence of yeast may provide
an unfriendly environment for sperm, most likely because the PH levels of the vagina are
affected by yeast infections. A word of caution to those who are experiencing a yeast infection
during their menstrual cycle. They are at risk of developing a serious condition in which the
infection spreads into the intestine. This can cause irritable bowel syndrome, diarrhea, bloating
as well as other unpleasant symptoms. This patient did do as asked and she filled her prescription
and it did clear up.
Prevention of Vaginal Candidiasis is simple. Females should avoid wearing tight pants,
pantyhose, tights, or leggings, avoid using feminine deodorant or deodorant tampons or pads,
don’t sit around in wet clothing, especially bathing suits, eat a well-balanced diet, eat yogurt or
take supplements with lactobacillus, wear natural fibers such as cotton, linen, or silk, avoid
sitting in hot tubs or taking frequent hot tub baths, wash underwear in hot water, avoid douching,
and replace old feminine products frequently. Additionally, if a woman and her partner are
presently attempting to conceive a child, an untreated yeast infection may make that process
difficult. The presence of yeast may provide an unfriendly environment for sperm, most likely
because the PH levels of the vagina are affected by yeast infections. These are all ways that
women can prevent themselves from growing their very own Vaginal Candidiasis.
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Works Cited
Bauman, Robert W. Ph. D. Microbiology with Diseases by Body System: Books a La Carte
Edition. Place of Publication Not Identified: Benjamin-Cummings, 2014. Print.
Faro, Sebastian. Sexually Transmitted Diseases in Women. Philadelphia: Lippincott Williams &
Wilkins, 2003. 133. Print. mic. Web. 19 Oct. 2016.
Gregory, Tanya. "The quandary of recurrent vaginal candidiasis." Patient Care 30 Jan. 2000:
123. Health Reference Center Academic. Web. 19 Oct. 2016.
Hamad, Mawieh. "Estrogen treatment predisposes to severe and persistent vaginal candidiasis in
diabetic mice." Journal of Diabetes and Metabolic Disorders 8 Jan. 2014: 15. Health
Reference Center Academy
Schaller, Martin, et al. "Models of oral and vaginal candidiasis based on in vitro reconstituted
human epithelia." Nature Protocols 1.6 (2006): 2767+. Health Reference Center
Academic. Web. 21 Oct. 2016.
