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Healthy habits are the best way to avoid disease. But in the chaos of a woman’s daily life healthy living is not at all followed now a days. Along with overall health of a women vaginal health is also an important part. A healthy woman is a promise of a healthy life. Woman has to pass through different stages and phases of life in which physical and psychological changes occur. Also, she has to fulfil the dual responsibility at home as well at job. Hence, she needs perfect physical and psychological health. Safe, healthy and confident life is very much necessary, for that every woman needs a healthy yoni. An infection or change in the normal balance of vaginal yeast and bacteria can cause inflammation of the vagina. Shweta pradara is an annoying symptom which is present in many diseases or present a complication. Since Shweta Pradara is a symptom, not a disease, hence etiopathogenesis of principal disease would be etiopathogenesis of Shweta Pradara also. It can be said that it is a Kaphaja disorder in the region of Apana Vayu. Infections due to certain organisms in vagina and uterus also lead to white discharge. A female patient suffering from Shweta pradara was treated by Shamana chikitsa and Yoni prakshalana. She got excellent relief in symptoms by above treatment.

This review includes a detailed overview of the vaginal yeast infection based on current literature available, addressing etiology, epidemiology, risk factors, and pathophysiology, as well as clinical presentation, burden, diagnostic, and treatment strategies. There are multiple meta-analyses, systematic reviews, randomized control trials, and critical reviews recently published that have advanced the understanding of pathophysiology and answered questions regarding global burden, prevention, and treatment in a systematic way. In the recent years, important work has been made to better understand the pathophysiology and global burden behind the vaginal yeast infection. Diagnostic criteria were proposed for chronic vulvovaginal candidiasis. While fluconazole resistance has been making maintenance suppressive therapy of recurrent vulvovaginal candidiasis difficult and probiotics do not seem to be very effective, significant improvements and advances in the area of antifungal therapeutic innovation research have been made and further results of vaccine trials are pending. There is a need for well-designed RCTs in evidence-based treatment development and research.

ObjectivesWe evaluated the relationship of sexually transmitted infections (STIs) and genital infections during pregnancy and subsequent risk for infant mortality and stillbirth.MethodsThis was a nested longitudinal analysis using data from a study of peripartum HIV acquisition in Kenya. In the parent study, HIV-uninfected women were enrolled during pregnancy and followed until 9 months postpartum. For this analysis, women who tested positive for HIV at any point, had a non-singleton pregnancy or a spontaneous abortion Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Syphilis was diagnosed using rapid plasma reagin testing and genital ulcer disease (GUD) identified by clinical examination. Treatment of laboratory-confirmed STIs and syndromic management was provided per Kenyan national guidelines. Predictors of stillbirth and infant mortality were determined using logistic regression and Cox proportional hazards models.ResultsOverall, among 1221 women, 55% had STIs or genital infections detected: vaginal yeast (25%), BV (22%), TV (6%), CT (5%), NG (2%) and syphilis (1%). Among women with STIs/genital infections (n=592), 34% had symptoms. Overall, 19/1221 (2%) women experienced stillbirths. Among 1202 live births, 34 infant deaths occurred (incidence 4.0 deaths per 100 person-years, 95% CI 2.8 to 5.5). After adjustment for maternal age, education and study site, stillbirth was associated with maternal GUD (adjusted OR=9.19, 95% CI1.91 to 44.35, p=0.006). Maternal NG was associated with infant mortality (adjusted HR=3.83, 95% CI1.16 to 12.68, p=0.028); there was some evidence that maternal CT was associated with infant mortality. Stillbirth or infant mortality were not associated with other genital infections.ConclusionsSTIs and genital infections were common, frequently asymptomatic and some associated with stillbirth or infant mortality. Expediting diagnosis and treatment of STIs in pregnancy may improve infant outcomes.

Antibacterial therapy may enhance the risk of symptomatic vulvo-vaginal candidosis in susceptible women. We addressed the question whether oral antifungal treatment for vulvo-vaginal candidosis also influences the bacterial vaginal microflora. One hundred and forty-two patients with a culture-proven acute episode of recurrent vulvo-vaginal candidosis (RVC) were treated with fuconazole according to the ReCiDiF regimen (induction dose of 600 mg orally per week followed by 200 mg per week) or with a single dose of 200 mg pramiconazole, a new potent oral triazole. At inclusion, 1 week and 1 month after the end of antifungal treatment, the bacterial microflora was assessed by microscopy of vaginal fluid to detect lactobacillary grades and bacterial vaginosis (BV). The presence of BV was studied in these patients with vulvo-vaginal candidosis after treatment with antifungal medication. At the start of oral antifungal treatment, 6.3% of women with Candida were co-infected with BV. Of the BV-negative women, 10 out of 133 (8%) developed BV after 1 week and after 1 month 8 of them (7%) were still BV-positive. Although no patients received antibacterial treatment at any moment of the study, 6 out of 9 (66%) of the women with Candida and BV at inclusion no longer had BV 1 week after antifungal treatment and 6 out of 7 (86%) lacked BV after 1 month. Treatment with antifungals may have a beneficial effect on women with concurrent BV, but does not prevent BV from occurring in BV-negative women with Candida vaginitis.

Zusammenfassung: Der prapartale vaginale Hefebefall bei Schwangeren zeigte in fruheren Jahren eine gleichbleibende Haufigkeit von ca. 30 Prozent. 1972 wurde in der Rheinischen Landesfrauenklinik eine Kontamination von 27,6 Prozent ermittelt. In den seither vergangenen zehn Jahren haben diagnostische Methoden in der gynakologischen Praxis erheblich Boden gewonnen, die Forderung nach einer antepartalen vaginalen Hefebeseitigung ist den Frauenarzten intensiv nahegebracht worden. Die jetzt vorgelegte Untersuchung erbrachte eine Senkung der allgemeinen vaginalen Hefekontamination auf 21,4 Prozent. Die unterschiedliche Betrachtung der Kollektive Deutsche/Auslanderinnen zeigt, das die Kontaminationsrate bei Auslanderinnen mit 28,8 Prozent unverandert ist. Die Ursache darf in einer mangelnden Therapiecompliance dieser Patientengruppe gesehen werden. Im Kollektiv der deutschen Frauen wurde die Kontaminationsrate auf 17,7 Prozent gesenkt. Dies entspricht einer relativen Senkung der Hefebefallsrate von 1972 um 35,9 Prozent. Eine weitere Senkung durfte durch Verbesserung der Untersuchungsqualitat ante partum und weiterer konsequenter Forderungen nach Sanierung der mutterlichen Geburtswege erreicht werden. Summary: In recent years, the antenatal vaginal yeast contamination has to be known to be about 30 per cent. In 1972, the contamination in the Rheinische Landesfrauenklinik Wuppertal was found to be 27.6 per cent. In the recent ten years, diagnostic methods of gynecologic practitioners have been improved considerably. The demand for an elimination of the antenatal vaginal yeasts was repeated intensively. This study shows a diminution of the common antenatal vaginal yeast contamination to 21.4 per cent. The selective view of the different collectives of German and foreign women, however, shows an unchanged contamination rate of the foreign women. The reason is seen in an restricted compliance for therapy of this group of patients. In the German collective, the contamination rate is reduced to 17.7 per cent, which is equivalent to a relative reduction of the vaginal yeast contamination of 1972 to 35.9 per cent. A further diminution should be possible by a better quality of the investigations ante partum and a further consequent demand for sanitation of the mother's birth-channel.

Summary. A study of the vaginal yeast flora in pregnant women living in Cusco and in its region (Peru), located approximately 3000 m above sea level, is reported. We observed 300 pregnant, healthy and non-diabetic women who attended a gynaecological clinic in the Lorena, Regional or IPSS (Institute Peruano de Seguridad Social) hospitals in Cusco. A comprehensive clinical history was obtained from each patient. It included age, work, parity, time of pregnancy, use of contraceptives or antibiotics, type of vaginal symptoms, type and amount of vaginal secretion. The yeasts were isolated from 44.3% of the cases. The positive cases were more frequently found in the following categories: 20–30 year-old patients (69.2%), ninth month of pregnancy (49.6%), first pregnancy (41.4%), no delivery (58.7%) and no abortion (66.9%). Most women complained of leukorrhea (75.9%) with mucus, scarce without odour (18.8%) or lumpy, regular, without odour (15.8%) secretion. The yeasts isolated were Candida albicans (66.2%), other Candida species (12.8%), Torulopsis glabrata (8.3%) or other Torulopsis species (2.2%), Saccharomyces cerevisiae (7.5%), Rhodotorula sp. (1.5%) and Tricho-sporon cutaneum (1.5%). Zusammenfassung. Es wird uber die vaginale Hefeflora bei Schwangeren in Cusco, Peru, und Umgebung berichtet, einer Region, die etwa 3000 m uber dem Meeresspiegel liegt. In die Studie eingeschlossen wurden 300 schwangere, nicht-diabetische, anderweitig gesunde Frauen, die die gynakologische Kliniken in Cusco oder in der Lorena-Region aufsuchten. Von jeder Patien-tin wurde ein ausfuhrlicher klinischer Bericht aufgenommen, der Alter, Beschaftigung, Zahl der Schwangerschaften, Schwangerschaftsstatus, fru-here Anwendung von Kontrazeptiva und Anti-biotika, Art der vaginalen Symptomatik sowie Typ und Ausmas der Vaginalsekretion umfaste. Von 44.3% der Patientinnen wurden Hefen iso-liert. Hefepositivitat wurde haufiger in folgenden Kategorien gefunden: 20-30 Jahre alte Patientinnen (69.2%), neunter Schwangerschaftsmonat (49.6%), Erstschwangerschaft (41.4%), Frauen ohne bisherige Entbindung (58.7%), Frauen ohne bisherigen Abort (66.9%). Die meisten Frauen klagten uber Leukorrhoe (75.9%) mit Schleimflus, wenig Ausflus jedoch mit Geruch (18.8%) oder klumpige regelmasige Sekretion ohne Geruch (15.8%). Die isolierten Hefearten waren Candida albicans (66.2%), andere Candida-Arten (12.8%), Torulopsis glabrata (8.3%), andere Torulopsis-Arten (2.3%), Saccharomyces cerevisiae (7.5%), Rhodotorula-Arten (1.5%) und Trichospo-ron cutaneum (1.5%).

Problem: Alle antimykotischen Therapien bei chronisch rezidivierender Vaginalkandidose (CRVC) sind unbefriedigend, solange es keine Immuntherapien gibt. Methode: Es wurden 3 Gruppen von je 30 nicht schwangeren Frauen zwischen 18 und 67 Jahren (6 postmenopausal, aber hormonsubstituiert) mit CRVC im Jahr 2002 und 2003 untersucht mit Vaginalnativpraparat, Hefepilzkultur mit Artbestimmung, Messung des Interleukin-(IL-)10, -12, -13 und -16, vaginalem sekretorischem und peripherem IgA, periphere T-Leukozyten-Subpopulation, IgM, IgA und IgG bei Visite 1 vor der Behandlung, Visite 2 6–12 Wochen und Visite 3 12 Monate spater. Alle Patienten beantworteten validierte Fragebogen zum Gesundheitsstatus (SF-36) und zur Lebensqualitat (PLC) und 20 eigene, nicht validierte Fragen uber die Kandidose, ihre Sexualitat und ihre Lebensqualitat. Die Laktobazillusvakzine mit 7 × 109 inaktivierten Laktobazillen von 8 verschiedenen Spezies (Gynatren®, Strathmann, Hamburg, Deutschland) wurde 3-mal alle 2 Wochen intramuskular injiziert (Gruppe 1). Die Heliotherapie (Gruppe 2) wurde entsprechend dem medizinisch ermittelten Hauttyp mit Ultraviolett-A- und ‐B-Strahlen 3-mal pro Woche fur 6 Wochen durchgefuhrt (Tancan 8000, Dr. Kern, Driedorf). Ciclopyroxolamin-100‐mg-Vaginaltabletten (Taurus Pharma, Frankfurt) wurde 6 Tage lang einmal taglich gegeben (Gruppe 3). Die Beschwerden der CRVC reduzierten sich signifikant von 6,3- zu 1,5-mal pro Jahr in allen Gruppen, ohne dass die positiven Pilzkulturen sich entscheidend anderten. Die Scores fur Lebensqualitat und Gesundheitsstatus wurden signifikant in den Gruppen 2 mit einigen Vorteilen in Gruppe 1 verbessert. Die peripheren T-Lymphozyten wurden in allen Gruppen ohne Signifikanz aktiviert. Vaginales IL-13 als Mediator von Allergien sank signifikant in den Gruppen 1 und 2 mit Korrelation zum klinischen Erfolg ab. Das antiinflammatorische IL-10 sank nicht signifikant in allen Gruppen ab. Viele Patienten auserten Symptome, ohne dass die Pilzkultur positiv war. Ergebnis: Die Immunmodellation durch die Injektion einer Laktobazillusvakzine oder eine Heliotherapie sowie das intensive personliche Kummern durch die Studienarzte konnte die Lebensqualitat von Patientinnen mit CRVC verbessern. Objective: All antimycotic therapies for chronic recurrent vulvovaginal candidosis (CRVS) are unsatisfactory as long as there is no immunotherapy. Methods: Three groups of 30 non-pregnant women aged between 18 and 67 years (6 post-menopausal, but with hormone replacement therapy) with CRVC were investigated in 2002 and 2003 by vaginal smear, yeast culture with species determination, the measurement of interleukin (IL) 10, 12, 13 and 16, vaginal and peripheral secretory IgA (sIgA), peripheral T-leucocyte subpopulations, IgM, IgA and IgG prior to treatment, and 6–12 weeks and 12 months after treatment. All patients answered validated questionnaires about their health (SF-36) and quality-of-life (PLC) and 20 own non-validated questions about their candidosis, sexuality and quality-of-life. Lactobacillus vaccination consisting of 7 × 109 inactivated lactobacilli of 8 species (Gynatren®, Strathmann, Hamburg, Germany) was administered 3 times by intramuscular injection every 2 weeks (group 1). Group 2 had heliotherapy performed according to skin type with suberythematous doses of ultraviolet A and B rays administered 3 times per week for 6 weeks (Tancan 8000, Dr. Kern, Driedorf, Germany). Ciclopyroxolamine (100 mg) vaginal tablets (Taurus Pharma, Frankfurt, Germany) were given once a day for 6 days to patients in group 3. Results: Clinical signs of CRVC decreased significantly from a mean of 6.3 to 1.5/year in all groups, but vaginal yeast cultures did not. Quality-of-life and health status scores were significantly better after treatment in groups 1 and 2 with a slightly higher improvement in group 1. Peripheral T‐lymphocytes were unsignificantly activated in all groups. Vaginal IL-13 as a mediator of allergy decreased significantly in groups 1 and 2 and this decrease correlated with clinical success. Anti-inflammatory IL-10 decreased in all groups but this decrease was not significant. Many patients suffered from symptoms but had negative yeast cultures. Conclusion: Immunomodulation with the injection of a lactobacillus vaccine or heliotherapy and intensive personal care can help to improve the quality-of-life of patients with CRVC.

In contrast to women who experience infrequent episodes of candidal vaginitis, patients with chronic and recurrent candidal vaginitis rarely have recognizable precipitating or causal factors. Analysis of vaginal yeast isolated from women with recurrent candidal vaginitis uncommonly reveals a higher percentage of non-albicans Candida species. There is no indication that resistance to azoles is a causal factor, and no other fungal virulence factors have been identified to explain the repeated attacks. Strain typing of sequential clinical isolates by means of molecular techniques indicate a pattern of relapse due to persistent yeast in the vagina rather than frequent vaginal reinfection. Attempts to reduce the number of attacks by treating sexual partners and suppressing a gastrointestinal tract focus have failed. Recent immunological studies suggest the possibility that an acquired Candida antigen-specific immunological deficiency results in uncontrolled vaginal Candida proliferation and hence repeated clinically evident attacks. Although no definitive cure for recurrent candidal vaginitis exists, numerous therapeutic maintenance regimens with azoles are available that effectively control symptomatic infection.

We sought to investigate the prevalence and risk factors for vaginal yeast colonization over a 1-year period.We conducted a longitudinal cohort study of 1,248 asymptomatic young women by collecting demographic and behavioral data at baseline, 4, 8, and 12 months.Seventy percent of women were colonized by vaginal yeast at one or more visits, but only 4% were colonized at all 4 visits. Using an adjusted generalized estimating equation model, factors associated with vaginal yeast colonization were marijuana use in the previous 4 months, depomedroxyprogesterone acetate use in the past 4 months, sexual intercourse in the previous 5 days, and concurrent colonization with lactobacilli and group B streptococcus. Symptoms of pruritus and vulvovaginal burning were associated with yeast colonization, but antifungal use was not.Recent sexual intercourse and use of injection contraceptives are risk factors for yeast colonization. Rates of antifungal use did not show an association with yeast colonization. The reporting of antifungal use by women lacking yeast colonization suggests that self-diagnosis is inaccurate.II-2.

Vulvovaginal candidiasis (VVC) is a common condition and usually straightforward to treat. In contrast, complicated VVC can be intractable and cause considerable psychological morbidity. Complicated VVC includes recurrent or severe disease, or when there are adverse factors in the host.1 This includes persistent infection with species other than Candida albicans (‘non- C albicans ’) and the more common recurrent albicans VVC. The importance of distinguishing the two conditions is that non- C albicans chronic vaginal yeast infection is potentially completely curable, but may need a different approach in terms of treatment modalities.2–7 This article suggests a stepwise approach to treatment using the best current evidence and the clinical experience of the authors and focuses on C glabrata since this species is responsible for the majority of cases. Other species and indeed other genera such as Saccharomyces cerevisiae can also be involved but less frequently (see supplementary table 1). Vaginal infection with non- C albicans may occur at any age and series from India and elsewhere suggest that uncontrolled type 2 diabetes is a risk factor.8 Symptoms may sometimes stretch back over many years with a long history of misdiagnosis and frustration. At least one swab identified to species level is an essential part of the diagnostic workup of any woman presenting with chronic or persistent vaginitis. Usually, but not always, the yeast is present in large amounts and is visible on microscopy. In the event of a positive swab a repeat sample should be sent to confirm. Relatively asymptomatic cases occur and clinically it can sometimes be difficult to be sure how much of a contributor the organism is to symptoms. This is sometimes only clear after eradication and even then symptoms can be very slow to settle. By the time patients present with a non- C …

Objective The purpose of this study was to determine the accuracy of rapid vaginal yeast detection assay compared with yeast cultures for the diagnosis of vulvovaginal candidiasis. Study Design This was a prospective study that involved 104 subjects, 34 asymptomatic women and 70 symptomatic women with vaginitis. Vaginal swabs were obtained from all subjects for wet mount, yeast culture, and the rapid yeast detection test. Overall, the prevalence rate was 39.4%, based on positive yeast cultures. The rapid yeast test performed by the physician was positive in 30 of 41 subjects with positive cultures and 13 of 63 subjects with negative cultures. Results The rapid yeast test had 73.1% sensitivity and 82.0% negative predictive value compared with the wet mount, which had 43.9% sensitivity and 70.9% negative predictive value. In symptomatic patients, the test had 77.4% sensitivity and 81% negative predictive value compared with wet mount, which had 51.6% sensitivity. Patient-performed test results were identical to the tests that were performed by the physicians. The cost of the rapid yeast test kit is estimated to be Conclusion Rapid yeast detection assay is accurate and affordable compared with the gold standard yeast culture in the diagnosis of vulvovaginal candidiasis. Relative to the wet mount, it is more sensitive, cheaper, and accurate for the rapid diagnosis of vaginal yeast infection.

Two groups of women with non-specific genital infection were treated for two weeks with tetracycline 250 mg six-hourly and minocycline 100 mg twice daily respectively. Cultures for yeasts were performed before treatment and at the end of the first and second weeks. Before treatment yeasts, mostly Candida albicans, were recovered from 13% of the women. After one and two weeks' treatment yeasts were isolated from 22 and 29% of women treated with tetracycline, and from 19 and 29% of women treated with minocycline. It is concluded that despite inhibition of the growth of yeasts shown by minocycline in vitro, there is no evidence of any significant difference between the actions of tetracycline and minocycline on the vaginal yeast flora.

PIP: During the years 1979-80, 8314 patients in a gynecologic practice were examined without any selection for vaginal yeast and trichomonas infection. The amount of yeast in all patients was 26.4% (1979: 29.5%; 1980: 23.5%). Trichomonas infection was found in 1.52% (1979: 2.18; 1980: 0.91%). An annual diagram was prepared from the individual monthly percentages, and it shows an increase in vaginal yeast in both summers (summer peak) and a decrease in the winter. The 2 diagrams differ slightly. Causes are discussed. The highest amounts of vaginal yeast were found in pregnant women: 35.5% (1979: 46.8% and 1980: 28.4%). In patients using oral contraceptives (OCs), we found yeast in 28.8% as compared with women of the same age not using OCs (20.3%). There is no direct relationship between the duration of use of OCs and the amount of vaginal yeast as was expected from previous research. On the contrary, the highest amount of vaginal yeast was found in the group of patients who had been using OCs for up to 2 years (32.4%). In the group taking OCs for more than 6 years, we found the lowest amount (21.6%). The groups using OCs for up to 4 years and up to 6 years showed results falling between the 2 (26% and 29%). In the postmenopausal patients, we found yeast in 15.6%. Possible causes and connections are discussed. All results were examined for statistical significance. A general increase in yeast infections during the years 1979-80 could not be ascertained by the authors. (author's)

Vaginal yeasts from 992 full-term pregnancy parturients in the delivery room were cultured and identified. Yeasts were similarly cultured from the mouth of the newborns seven days after birth to find out whether a viable yeast infection had taken place. Anamnestic data concerning genital infection earlier or during the present pregnancy were collected from the parturients. The yeast findings are compared with results from similar cultures from gynecologic out-patients. Vaginal yeast infection had been diagnosed before the present pregnancy in 16.5 per cent and in some phase of the present pregnancy before the delivery in 8.5 per cent of the parturients. A positive yeast culture with no clinical symptoms during the pregnancy was found in 9.9 per cent. Clinical symptoms were present in 61 per cent of the yeast culture positive parturients. Altogether 3 155 specimens were studied and 670 yeasts were identified. Positive yeast cultures from parturients were obtained in 23.7 per cent and from gynecologic patients in 30.9 per cent. Candida albicans was the most common yeast. It was followed by Saccharomyces cerevisiae in the parturients and Torulopsis glabrata in the gynecologic patients. Pityrosporum ovale/orbiculare was also common in the latter material. S. cerevisiae as well as Pityrosporum species are usually not identified in the medical yeast laboratories, for methodological reasons. Positive yeast culture from the mouth of the newborns were obtained only in 20 cases. A symptomatic oral candidosis was not present in any of the cases.

The Oricult-N semiquantitative dipslide (Orion Diagnostica, Espoo, Finland) was evaluated for the laboratory diagnosis of vaginal candidiasis. It was compared with broth culture (Vagicult; Orion Diagnostica). Oricult-N was positive for 14.5% of 124 symptomatic patients and 12% of 50 asymptomatic controls. The results for broth cultures were 17 and 22%, respectively. Thus, the test group and the control group did not differ significantly by either method. High vaginal yeast counts (≥10 5 CFU/ml) were detected by Oricult-N in 7% of patients and in 0% of controls, but both groups harbored low numbers of yeasts. An accurate quantitative cutoff point separating a level of yeast associated with infection from vaginal yeast carriage could not be defined in the study. Nevertheless, the easy semiquantitation allowed by the Oricult-N method could be helpful because, especially in low-count carriers of Candida , other potential causes of vaginal symptoms should be considered. The Oricult-N method was technically simple and could be applied in primary health care. Further studies are required, however, before Oricult-N can be recommended as a routine diagnostic tool.