Candida (Yeast) Infection

What is a Candida infection?

A Candida infection (Candidiasis) is a fungal (yeast) infection by any of several species belonging to a genus (group) of fungus called Candida. Most fungal infections are superficial, involving the skin or nails, the vagina, and vulva (vulvovaginal candidiasis [VVC], sometimes called vulvovaginitis), or other mucous membranes, such as the mouth. However, some fungus infections are classified as invasive, meaning that the fungus has infected the bloodstream (candidemia) and/or various internal parts of the body, including the lungs or the layers around the brain. Most fungal infections in humans are caused by a species of fungus called Candida albicans Among non-C. albicans infections, most are caused by any of the following other four Candida species: Candida glabrata, Candida tropicalis, Candida parapsilosis, or Candida krusei.

How common is candidiasis during pregnancy?

Fungal infections of the skin and genitals are very common, and women are at higher risk of becoming infected compared with men, although men and women have the same risk of developing an invasive Candida infection. If you are generally healthy, you are very unlikely to develop an invasive Candida infection, but superficial Candida infections, particularly VVC, are extremely common, just as they are common outside of pregnancy. Pregnancy actually makes you more prone to Candida infection, especially during the third trimester.

How is candidiasis diagnosed?

When it comes to candidiasis on the skin, nails, or vagina-vulva, if you are generally healthy, your doctor often can make a diagnosis clinically, by seeing and noting a particular appearance of the fungal lesions on the skin (red lesions on skin, and pustules on places where hair grows) or the discharge and reddening of the genitals, and sometimes the odor of the discharge. In these cases, typically, the history of the symptoms for VVC, these consist of itching and discharge plus the findings of the physical exam will make the physician confident enough to make a diagnosis of C. albicans. On the other hand, for patients with complex issues, such as co-existing health issues for which they are receiving medications or recurring Candida infections, your doctor will take a sample for examination under a microscope, and for other laboratory tests. Looking at the samples under a microscope, the examiner (usually a clinical pathologist) will see characteristic features of the Candida organism, and help to determine if it is indeed C. albicans, if it is one of the four other Candida species that are fairly common, if it is a rare fungal infection, or if non-fungal organisms are complicating the picture

Candidiasis inside the gastrointestinal tract requires a procedure called endoscopy to draw out a sample for testing under a microscope. Diagnosis of Candida that has invaded through the bloodstream and body tissues often can be achieved by growing the organism from blood samples. Imaging, such as computed tomography (CT) and ultrasound also can reveal evidence of fungal infection. When a fungal infection in the brain or spinal cord is suspected, doctors also need to take samples of cerebrospinal fluid for analysis through several laboratory tests, which can include antibody testing and growing the organism in the laboratory.

Does Candidiasis cause problems during pregnancy?

Invasive Candida infections put the mothers health and life at risk. Candidemia (fungal infection in the blood) for instance, can cause whats called septic shock and also can lead to infection of the inner layer of the heart (endocarditis), of the connective tissue layers around the brain (meningitis), or of the bone (osteomyelitis). Candida infections of the vagina-vulva, the skin, the nails, and the gastrointestinal tract can become chronic persistent and difficult to eliminate.

Does Candidiasis during pregnancy cause problems for the baby?

Invasive Candida puts the life of the developing baby at risk, though as noted above invasive Candida infection is unlikely if you are healthy. VVA and other superficial Candida infections do not put the baby at a particular risk.

What to consider about taking medications when you are pregnant or breastfeeding:

• The risks to yourself and your baby if you do not treat the Candida infection
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat Candida infection during pregnancy?

The main medications used against VVC and on Candida infections in other superficial areas, such as the skin and nails are called triazole antifungals. These include clotrimazole, miconazole, fluconazole, and voriconazole. Another drug is called ciclopirox, and another category is called the polyene antifungals, which includes nystatin. Some of these medications are available as a topical cream, others to swallow orally, and some come in both oral and topical forms. For treating surface fungal infections and VVC, the first choice is always to use a topical cream; virtually all of the anti-fungal drugs that are given topically or into the vagina are considered safe to use during pregnancy.

The polyene category also includes the drug amphotericin B, which is given intravenously in most cases to treat fungal infections deep inside the body (invasive infections). Finally, there is a drug category called pyrimidine analogues. These are given orally (in pill form) to combat fungal infections in the brain and heart, sometimes in combination with amphotericin B. Not much is known about the anti-fungal drugs that are injected, so doctors are awaiting more information. While fluconazole is safe when given as a pill against vaginal fungal infections that dont go away with a cream, when injected for high-dose treatment of invasive fungal infections during the first trimester of pregnancy, fluconazole may be harmful to the developing baby. In contrast, Amphotericin B a drug that is notorious for its side-effects is considered fairly safe for the developing baby when the mother requires intravenous anti-fungal treatment.

Who should NOT stop taking medication for Candidiasis infection during pregnancy?

So long as the anti-fungal drug is selected appropriately for your condition and pregnant status, there is no reason to stop taking it.

What should I know about choosing a medication for my Candida infection during pregnancy?

You may find Pregistrys expert reports about the individual medications to treat infections here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my Candida infection when I am breastfeeding?

All topical and vaginal anti-fungal creams can be used safely by mothers who breastfeed.

What alternative therapies besides medications can I use to treat my candidiasis during pregnancy?

There is no alternative to anti-fungal medications, but you can reduce your risk of developi
ng a fungal infection by drying off as soon as you are finished swimming or exercising, and by using antibiotics only for the prescribed duration of treatment (dont take extra).

What can I do for myself and my baby when I have candidiasis during pregnancy?

Use the medication that your doctor prescribes, or recommends. For uncomplicated cases of VVC, generally, your doctor can simply refer you to your local pharmacy where you can obtain an over-the-counter anti-fungal cream.

Resources for Candida in pregnancy:

For more information about Candida infections during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

• Mayo Clinic: Yeast infection during pregnancy: Are over-the-counter treatments OK?
• What to Expect: Yeast Infection During Pregnancy