In most cases, the causative agent of candidiasis is Candida albicans species .
Even in perfectly healthy individuals, candida is part of the normal microbial flora of the body, and proliferates without causing any kind of damage. Under certain circumstances, however, this habitual guest of the skin, mouth, gastrointestinal tract, and vagina may find itself at an “advantage” over the immune system . The candida thus begins to proliferate excessively causing damage; in other words, these fungi take on the role of pathogens and create a complex series of ailments in both men and women.
When Does Candida Become Pathogenic?
Mycoses are diseases caused by fungi. Among these, one of the most widespread and well-known is candidiasis, more simply known as candida, a pathology that can potentially affect any part of the body.
The fungus that causes candidiasis ( Candida albicans and other Candida species) is a common, commensal , and saprophytic (organism that feeds on dead organic matter) that lives on the intestinal lining of many healthy individuals. It is estimated that Candida colonies are present on the mucous membranes ( oropharynx , gastrointestinal tract, vagina) of 80% of healthy individuals.
By itself, in fact, candida is a yeast which in some respects lives in symbiosis with the human body, participating in the digestion of sugars, even if in reality it is more correct to define it as a saprophytic organism. Normally, the colonies of these fungi multiply with the intake of foods and especially sugars. However, the efficiency of the human immune system is sufficient to control its proliferation, even in the case of a high carbohydrate diet .
Rarely, candida becomes pathogenic and produces candidiasis. This condition is established more easily following the prolonged use of antibiotics and during intense psychophysical stress which lower the patient’s immune defenses (such as HIV infection ).
Locations Affected By Candida
Due to its presence in numerous districts of the body, Candida is able to induce infections of variable entity in different locations. In fact, candidiasis includes different types of infections, ranging from the most superficial to the systemic level.
Superficial infections caused by Candida are responsible for local inflammation , often associated with intense discomfort. An example of superficial candidiasis is thrush or oral candidiasis , characterized by the appearance of white patches on the tongue, tonsils and soft palate.
However, candida can also cause vaginitis , enteritis , and, in the most serious cases, pulmonary moniliasis and chronic endocarditis .
Definitely rarer, but much more fearsome, are systemic infections , which mostly affect immunosuppressed individuals , causing important complications, such as lung abscesses , endocarditis or meningitis .
Causes And Risk Factors
80% of candidiasis cases are due to Candida albicans infection , while the remaining 20% are caused by other species of fungi belonging to the same family ( Candida tropicalis 1%-5% and Candida glabrata 10%). The non-albicans forms of Candida are on the rise and are more frequently associated with relapses or HIV infection. These two causative agents are associated with the selection caused by the use of antibiotics (imidiazoles) specific for Candida albicans and less effective in fighting the other forms.
Candida: Risk Factors
The transition from the latent and asymptomatic colonization of these fungi (present in many healthy individuals) to a symptomatic infection (candidiasis) is favored by the following predisposing factors:
- Medicines such as corticosteroids and antibiotic therapies : weakening of the immune system.
- Oral contraceptives : High levels of estrogen appearto promote the growth of Candida.
- Hyperglycemia (untreated diabetes ): the presence of sugars favors the pathogenic action of these fungi.
- Decrease in the immune system caused by illnesses or major psycho-physical stress: HIV, chemotherapy , transplantation;
- Anemia ;
- Alcohol abuse and smoking ;
More generally, all situations or diseases that debilitate the body or lower the immune system can predispose to candidiasis.
Vulvo-vaginal candidiasis is a very common problem, especially among the female population of childbearing age. It is estimated, in fact, that about 75% of women experience this disorder at least once in their life. Of these, about 4-5% will develop a recurrent form of infection, i.e. they will experience at least 3 episodes of acute vaginal candidiasis in a year.
Candida albicans is once again responsible for vulvo-vaginal candidiasis . In any case, infections caused by other species of Candida are on the rise, and infections of mixed types, i.e. supported by both fungi and bacteria, are also on the increase .
As regards the possible causes of vaginal candidiasis, it should be reiterated that Candida albicans normally coexists with the body, without creating particular problems. However, in the presence of some favorable situations it can grow quickly and abundantly, becoming aggressive and causing very annoying symptoms.
Aggravating And/Or Predisposing Factors
Candida can be transmitted through sexual intercourse and through the shared use of towels or linen used by an infected person. It must be emphasized, however, that sexual transmission, unlike other vaginal infections , is of little significance. More often, in fact, the vulnerability to this mycosis is due to stress, diabetes, prolonged use of antibiotics or corticosteroids and imbalances in the normal vaginal or intestinal bacterial flora .
In fact, I remember that even in the vagina there is a specific microflora , made up of different types of microorganisms in mutual balance. In fertile women, in particular, the vagina is a slightly acidic environment, rich in good microorganisms, called lactobacilli , which protect it from infections. However, this balance can be upset by various factors, such as the use of aggressive intimate cleansers or the use of too tight or nylon underwear.
The use of oral contraceptives and the hormonal changes in estrogen that occur during the menstrual cycle and pregnancy have also been linked to the onset of candidiasis.
Symptoms Vulvo-Vaginal Candida
In women, acute vulvovaginal candidiasis manifests itself with intense itching of the genital mucous membranes, associated with the loss of whitish vaginal secretions . These losses, more or less abundant, frequently take on a thick and creamy appearance, similar to cottage cheese or curdled milk. Alongside these typical symptoms, local irritation and swelling, burning during urination and pain in the vulva are often associatedand the vagina, even during sexual intercourse. Precisely in reference to the latter, which in any case are often impracticable due to the associated discomfort, Candida can also infect the male genitals, causing a certain irritation, with redness, itching or burning of the glans .
In the presence of symptoms suggestive of a Candida infection, it is advisable to contact your doctor or gynecologist .
Once the symptoms and signs of the disease have been evaluated, the doctor will take a vaginal smear in women or a urethral swab in men. In this way it will be possible to analyze the biological sample thus taken in the laboratory, in order to isolate the responsible agent. In particular, after being grown in the laboratory on a specific culture medium, Candida colonies will appear round and white or cream in colour.
Like other fungal infections, candidiasis can also be treated with specific antifungal drugs , for example clotrimazole , miconazole and fenticonazole. The doctor usually prescribes local therapy, i.e. based on ovules and vaginal creams . More rarely, local therapy can be combined with systemic therapy, i.e. taking tablets orally .
It should be noted that recovery from candidiasis can be slow and, sometimes, treatment is not conclusive. In fact, it must be considered that the therapy is of the fungus-static type, i.e. it blocks the replication and proliferation of Candida, allowing the immune system enough time to eliminate it. Therefore, the disorder can be extremely difficult to control and can recur after discontinuation of therapy.
Candida infection, as we have seen, can affect various body mucous membranes and, depending on the infected area, it assumes different names ( vulvovaginitis , balanitis , balanoposthitis , thrush).
At the male genital level (see further information: candida in men ), the infection can cause, especially in diabetic subjects , the appearance of balanitis (pain, itchy redness on the surface of the glans) or balanoposthitis if the inflammation also extends to the foreskin .
Candida: Lifestyle And Diet
In the case of Candida infection, in addition to the early start of treatment, which moreover must be strictly adhered to, it is advisable to pay attention to nutrition and lifestyles.
- To prevent recurring infections, on the other hand, nutrition often plays a crucial role. Since these microorganisms feed on sugars, for a certain period it would be better to abolish or in any case drastically reduce foods containing refined sugars , such as sweets, sweets, industrial fruit juices and other sugary drinks. It is often advised to also avoid leavened foods, such as bread , focaccia , pizza and sweets of all kinds.
- As for the recommended foods, green light for fruit and vegetables , whole grains , yoghurt and lactic ferments . The latter are often the subject of specific supplements , promoted to fight candida, while at the pharmacological level there are specific preparations of lactobacilli to be applied directly in the vaginal area, precisely given the importance of the correct local microbial balance both in preventive and therapeutic terms. Among the fruit, the NOT sugary one should be preferred , thus limiting grapes , bananas , persimmons , figs and candied dried fruit.
- Among the potentially useful supplements there are glutamine ( an important nutrient both for the cells of the intestine and for those of the immune system) and immunostimulant and adaptogen herbal medicines , such as echinacea , uncaria tomentosa and eleutherococcus .
- The constant practice of physical exercise , regular night rest, the care in nutrition avoiding excesses, the optimal management of stress can certainly benefit the patient affected by relapsing candidiasis.
- As far as personal hygiene is concerned, this must be scrupulous, but at the same time delicate, so as not to alter the balance of the skin and mucous membranes. In any case, the intimate cleanser must be specific and not too aggressive, therefore free of fragrances or other potential allergenics . If in doubt, it is always useful to ask your gynecologist or pharmacist for advice.
- Finally, it is advisable to wear cotton underwear and avoid nylon, microfiber and too tight-fitting clothes. This is because Candida grows more in an anaerobic environment, that is, without air. Prolonged contact with synthetic fabrics should therefore be avoided as they can hinder the natural transpiration of the skin .