Fungal Infections: Symptoms and Treatment in Gynecology

Mold issues

Hello Doctor, two days ago I experienced symptoms of pain and itching in the genital area.
After seeing a doctor, I was diagnosed with a fungal infection, which was said to be not serious.
I was prescribed 6 tablets of Nystatin 500,000 U for 3 days and Pocommi-Nycindin ointment (15g).
However, after three days, there has been no improvement in my symptoms.
I have noticed swollen, clustered, granular formations along the inner sides of the labia, and there are streaks of blood when applying the medication, which is very painful.
Overall, the affected area has some blood streaks and swelling, but there is not much of the typical cottage cheese-like discharge.

I would like to ask the doctor if those clustered granular formations are a result of the infection or if they are pre-existing tissue that has become inflamed and swollen.
If they are indeed a result of the infection, should treatment continue until the granular formations disappear and the area is smooth for it to be considered healed? Additionally, the doctor did not prescribe any suppositories; is this because the condition is not serious or because I am inexperienced with sexual activity? This is my first gynecological issue, and I am very scared, fearing that if it is not healed, it will recur.
I kindly ask for your assistance.
Thank you.

Miss Sun, 40~49 year old female. Ask Date: 2016/07/10

Dr. Lin Manying reply Obstetrics and Gynecology

1.
The granular lesions on the vulva may be a result of post-infection irritation, or they may have been present originally; an examination is necessary to confirm.
2.
Some protrusions on the inner labia are normal papillary structures and do not necessarily need to be completely smooth; an examination is required to determine this.
3.
For individuals with no sexual experience, the use of suppositories for treatment is generally not recommended.

Reply Date: 2016/07/10

More Info

Fungal infections, particularly those caused by Candida species, are common in gynecology and can lead to a range of uncomfortable symptoms. Based on your description, it seems you are experiencing a Candida infection, which is often characterized by itching, burning, and abnormal discharge. However, your symptoms also include painful lesions and bleeding, which may indicate a more complex issue that requires careful evaluation.

Symptoms of Fungal Infections
The typical symptoms of a Candida infection include:
1. Itching and Irritation: This is often the first sign, and it can be quite severe.

2. Abnormal Discharge: The discharge is usually thick, white, and resembles cottage cheese. However, in some cases, the discharge may not be as pronounced.

3. Painful Urination or Intercourse: Inflammation can lead to discomfort during urination or sexual activity.

4. Redness and Swelling: The vulva and vaginal walls may appear red and swollen.

In your case, the presence of "granular" lesions along the labia and the associated pain and bleeding are concerning. These could be a result of inflammation due to the infection or could indicate a secondary issue, such as a different type of infection or a reaction to irritation.

Treatment Considerations
You mentioned being prescribed oral Nystatin and a topical cream, which are common treatments for fungal infections. However, if symptoms persist after three days of treatment, it is crucial to follow up with your healthcare provider. Here are some considerations:
1. Follow-Up: If there is no improvement, a follow-up appointment is essential. Your doctor may need to reassess your condition and possibly perform additional tests, such as a culture or a swab, to confirm the diagnosis and rule out other infections (like bacterial vaginosis or sexually transmitted infections).

2. Granular Lesions: The "granular" areas you describe could be inflamed tissue due to the infection. If these lesions are indeed a result of the infection, they may resolve with appropriate treatment. However, if they persist, further evaluation may be necessary to determine their nature.

3. Use of Suppositories: The absence of a vaginal suppository in your treatment plan may not necessarily indicate the severity of your condition. Some practitioners may choose to start with oral medications, especially if the infection is not severe. However, if symptoms do not improve, your doctor might consider adding a suppository to the treatment regimen.

4. Prevention of Recurrence: To prevent future infections, consider the following lifestyle modifications:
- Hygiene: Maintain good genital hygiene, avoiding irritants such as scented soaps or douches.

- Clothing: Wear breathable cotton underwear and avoid tight-fitting clothing.

- Diet: Some studies suggest that a diet low in sugar may help reduce the risk of Candida overgrowth.

- Probiotics: Incorporating probiotics may help restore the natural flora of the vagina.

Conclusion
It is understandable to feel anxious about your symptoms, especially if this is your first experience with a gynecological issue. Persistent symptoms warrant further evaluation to ensure that you receive the appropriate treatment. Do not hesitate to communicate your concerns with your healthcare provider, as they can provide guidance tailored to your specific situation. Remember, early intervention can help prevent complications and improve your overall health.

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