Many patients arrive at my surgeries in Milan or Florence with chronic candidiasis. One of the most important causes of so many annoying recurrences is self-medication, which is favoured by easily accessible information on Google.
In fact, the indiscriminate and repeated use of local or systemic antifungal drugs can lead to drug resistance. However, if you consult a trusted specialist in good time, they can tackle the problem much more effectively by not only providing targeted anti-Candida treatment, but also restoring the balance of vaginal flora and the microbiological ecosystem of the mucosa (increasing lactic acid-producing organisms and adjusting the pH). They can also advise on the correct lifestyle to prevent recurrences. To this end, I have decided to write this post, in the hope of helping people to avoid the harmful practice of self-medicating for this and other diseases.
What Candida is
Candida albicans is a saprophytic fungus (i.e. it feeds on dead cells) belonging to the Saccharomyces family. Under normal conditions, it is found alongside other microorganisms in the oral cavity, gastrointestinal and vaginal mucosae, and on the skin. It is active in the digestion of sugars through fermentation. However, it can only cause infections and inflammatory disorders, such as vaginitis (or balanitis in men), if there is an imbalance or lowered immune defences. It can also proliferate abnormally, causing candidiasis on other mucous membranes (for example, thrush in the oral mucosa).
Epidemiology
Vaginal candidiasis is so common that, in episodic form, it affects 50–75% of women at least once in their lifetime. In 4–8% of cases, it becomes a chronic infection that is sometimes difficult to treat. I find that these official statistics coincide remarkably well with my daily experience as a gynaecologist. As I mentioned previously, I increasingly diagnose this type of inflammation in women of all ages who visit me at my Milan office and at outpatient clinics in Florence.
Candida albicans is responsible for the majority of candida infections, while Candida tropicalis and Candida glabrata are more prevalent in cases of relapse following the use of imidazole antifungals or in individuals with HIV.
Causes of candidiasis
Disequilibria in the vaginal flora, such as Candida overgrowth, are often related to changes in vaginal pH, lactobacillus concentration and the degree of oxygenation and humidity in the vagina. These changes may be favoured by one or more of the following factors:
- Prolonged use of certain drugs, such as antibiotics, corticosteroids or contraceptives.
- General state of stress, after-effects of chemotherapy or transplantation.
- Hormonal changes, particularly those related to oestrogen (e.g. menstruation, pregnancy, menopause), and biological age.
- Sexual transmission
- General health conditions (e.g. hypoglycaemia, diabetes or HIV).
- Anaemia, alcoholism and smoking.
- Personal and partner hygiene (e.g. excessive use of aggressive intimate cleansers or deodorant sprays)
- Contact with synthetic fibres and overly tight-fitting clothing.
- Intestinal inflammation of the colon.
- A diet that is rich in refined sugars, ferments and yeasts, but poor in certain nutrients such as mineral salts, zinc and vitamins A, C and beta-carotene.
- Particular anatomical conformation of the vulvo-anal tract.
- Presence of food intolerances that favor intestinal inflammation.
- Frequenting ‘risky’ humid environments, such as gyms and swimming pools.
- Mercury from old dental fillings is also associated with an increase in candidiasis.
In particular, the antibiotic inhibits the production of nutrients, such as vitamin B, which is produced by balanced flora that maintain the correct pH level of intestinal soil.
Candidiasis symptoms
The most obvious symptoms of a candida infection are local itching and redness, sometimes accompanied by a burning sensation in the private parts, and whitish vaginal discharge.
However, general fatigue, mild intestinal or stomach discomfort, and, in some cases, red patches on the lower back, buttocks and thighs may also be present. You may also experience dysuria (pain when urinating) and dyspareunia (pain during sexual penetration).
Candida can also irritate and cause the skin to flake at the elbows, groin, anus and between the toes. If neglected, it can enter the bloodstream and affect other organs, potentially causing enteritis and, in rare cases, pulmonary moniliasis and chronic endocarditis.
Diagnosis
The diagnosis of vaginal candidiasis, particularly in serious cases, is made through an objective examination to check for the presence of the fungus. This involves taking a vaginal smear from women (colposcopy) and a urethral swab from men, which are then cultured in a laboratory.
Treatment
The main prophylaxis for mild female candidiasis involves the local application of antifungal ovules, creams or douches for a few days. More severe relapses or chronic inflammation caused by non-albicans Candida are treated with oral antifungal therapy involving longer courses of fluconazole, clotrimazole, econazole, itraconazole, nystatin or amphotericin B.
Candidiasis that develops during pregnancy or in conjunction with chronic diseases such as diabetes and HIV is classified as complicated and must be treated with targeted prophylaxis.
When treating candidiasis, it is essential to restore the balance of intestinal flora by introducing probiotics such as Enterococcus faecium, Saccharomyces boulardii, various bifidobacteria, Lactobacillus rhamnosus and acidophilus. The balance of Candida depends on the presence of ‘good’ intestinal flora, consisting of Bifidobacteria and Lactobacilli, which maintain the correct intestinal pH, make vitamins bio-available, and defend against pathogenic microorganisms.
Intimate hygiene
To maintain intimate hygiene, it is recommended to wash with milk enzyme products and use vaginal douches containing bicarbonate of soda, as this counteracts the overly acidic environment that the fungus prefers.
If you have candidiasis, it is best to avoid sexual intercourse to prevent exacerbating the symptoms and infecting your partner. If you have recurring symptoms, your partner should also be treated.
Anti candidiasis diet
A balanced diet combined with a healthy lifestyle and regular physical activity is well known to boost the immune system. In this case, it is recommended that you eliminate foods that can facilitate Candida colonisation, such as sugars and carbohydrates, and yeast. It is best to avoid sugar, alcohol, peanuts, rye, industrial foods, cured meats, smoked meats, tinned meats, sausages and hard cheeses, and to limit maize, wheat and barley. A diet based on vegetables, fruit and fibre is recommended, together with flax seeds, nuts and legumes as a source of omega-3, as well as yoghurt and other probiotic and prebiotic foods that are useful for balancing intestinal bacterial flora.
Candida produces an enzyme called thiaminase, which antagonises vitamin B1. Therefore, it is advisable to take a vitamin B complex alongside the anti-candidosis diet.
If you recognise the symptoms described here, I advise you to see your trusted gynaecologist or a specialist in your city for a correct diagnosis and appropriate treatment for candidiasis. If you would like a consultation with me, I see patients at my surgeries in Milan and Florence.