X72 Genital candidiasis female (ICD-10:B37.3)

Update: 2024-08-15

Description

Introduction

Genital candidiasis, also known as vaginal yeast infection, is a common condition caused by the overgrowth of Candida fungus in the vagina^[1]. It can cause discomfort and itching, and if left untreated, it may lead to complications^[2]. The aim of this guide is to provide a comprehensive overview of the diagnosis and management of genital candidiasis in females.

Codes

ICPC-2 Code: X72 Genital candidiasis female^[3]

ICD-10 Code: B37.3 Candidiasis of vulva and vagina^[4]

Symptoms

Itching and irritation in the vagina and vulva^[5]

Redness and swelling of the vulva^[6]

Thick, white, odorless vaginal discharge^[7]

Burning sensation during urination or intercourse^[8]

Causes

Overgrowth of Candida fungus, usually Candida albicans, in the vagina^[9]

Imbalance in the vaginal microbiota, such as a decrease in lactobacilli^[10]

Weakened immune system

Hormonal changes, such as during pregnancy or the menstrual cycle

Use of antibiotics or corticosteroids Uncontrolled diabetes

Diagnostic Steps

Medical History

Gather information about the patient’s symptoms, including the duration and severity

Ask about any previous episodes of vaginal yeast infections

Inquire about any recent antibiotic or corticosteroid use

Assess the patient’s medical history, including diabetes or immune system disorders

Determine if the patient is pregnant or experiencing hormonal changes

Physical Examination

Inspect the vulva and vagina for redness, swelling, or discharge

Perform a pelvic examination to assess the vaginal walls and cervix

Collect a sample of vaginal discharge for further testing, if necessary

Laboratory Tests

Microscopic examination of vaginal discharge: Presence of yeast cells and hyphae

Vaginal pH test: Elevated pH (>4.5) may indicate a yeast infection

Vaginal culture: To identify the specific Candida species causing the infection

PCR testing: To detect the presence of Candida DNA in the vaginal discharge

Diagnostic Imaging

Diagnostic imaging is not typically necessary for the diagnosis of genital candidiasis.

Other Tests

Blood glucose test: To screen for diabetes, especially in recurrent or severe cases

HIV test: If there are risk factors or suspicion of immunosuppression

Follow-up and Patient Education

Schedule a follow-up visit to assess the response to treatment and ensure resolution of symptoms

Educate the patient about the importance of maintaining good genital hygiene

Advise the patient to avoid douching, as it can disrupt the vaginal microbiota

Discuss the use of barrier methods during sexual intercourse to prevent reinfection

Provide information on the signs and symptoms of recurrent infections and when to seek medical attention

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Genital candidiasis:

Fluconazole (Diflucan):
- Cost: $10-$30 for a single dose.
- Contraindications: Hypersensitivity to fluconazole or other azole antifungals.
- Side effects: Nausea, headache, abdominal pain.
- Severe side effects: Severe skin reactions, liver toxicity.
- Drug interactions: Warfarin, certain benzodiazepines.
- Warning: Use caution in patients with liver or kidney disease.

Clotrimazole (Gyne-Lotrimin, Mycelex):
- Cost: $10-$20 for a 7-day treatment.
- Contraindications: Hypersensitivity to clotrimazole or other azole antifungals.
- Side effects: Local irritation, burning, itching.
- Severe side effects: Allergic reactions.
- Drug interactions: None reported.
- Warning: Avoid using tampons or douches during treatment.

Miconazole (Monistat):
- Cost: $10-$20 for a 7-day treatment.
- Contraindications: Hypersensitivity to miconazole or other azole antifungals.
- Side effects: Local irritation, burning, itching.
- Severe side effects: Allergic reactions.
- Drug interactions: None reported.
- Warning: Avoid using tampons or douches during treatment.

Terconazole (Terazol):
- Cost: $20-$40 for a 7-day treatment.
- Contraindications: Hypersensitivity to terconazole or other azole antifungals.
- Side effects: Local irritation, burning, itching.
- Severe side effects: Allergic reactions.
- Drug interactions: None reported.
- Warning: Avoid using tampons or douches during treatment.

Butoconazole (Gynazole):
- Cost: $20-$40 for a 3-day treatment.
- Contraindications: Hypersensitivity to butoconazole or other azole antifungals.
- Side effects: Local irritation, burning, itching.
- Severe side effects: Allergic reactions.
- Drug interactions: None reported.
- Warning: Avoid using tampons or douches during treatment.

Alternative Drugs:

Nystatin (Mycostatin): Available as a cream or suppository for the treatment of vaginal yeast infections. Cost: $10-$20 for a 7-day treatment.

Gentian violet: An antifungal dye that can be used for resistant or recurrent infections. Cost: $5-$10 per bottle.

Boric acid: Can be used as a suppository for recurrent or resistant infections. Cost: $10-$20 for a 14-day treatment.

Tea tree oil: Some evidence suggests that tea tree oil may have antifungal properties. Cost: $10-$20 for a bottle.

Surgical Procedures:

Surgical procedures are not typically necessary for the treatment of genital candidiasis.

Alternative Interventions

Probiotics: Oral or vaginal probiotics containing lactobacilli may help restore the balance of vaginal microbiota. Cost: $10-$30 for a month’s supply.

Tea tree oil: Diluted tea tree oil can be applied topically to the vulva for relief of symptoms. Cost: $10-$20 for a bottle.

Yogurt: Some women find relief by applying plain, unsweetened yogurt to the vulva. Cost: $2-$5 for a container.

Garlic: Inserting a garlic clove into the vagina may have antifungal properties. Cost: $1-$2 for a bulb of garlic.

Coconut oil: Applying coconut oil to the vulva may help soothe itching and irritation. Cost: $5-$10 for a jar.

Lifestyle Interventions

Good genital hygiene: Encourage the patient to keep the genital area clean and dry.

Avoid irritants: Advise the patient to avoid using scented soaps, bubble baths, and feminine hygiene products.

Cotton underwear: Recommend wearing breathable cotton underwear and avoiding tight-fitting clothing.

Avoid douching: Inform the patient that douching can disrupt the vaginal microbiota and increase the risk of infection.

Balanced diet: Emphasize the importance of a healthy diet to support immune function.

Stress management: Encourage stress reduction techniques, as stress can weaken the immune system.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

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