Healthy Living

Candida is a family of yeasts or fungi that can occur naturally on the skin, mucous membranes and in the intestines. This is also called commensalen. The most common Candida species is Candida albicans. Virtually everyone naturally has candida albicans yeasts on the skin, mucous membranes (of vagina, mouth, etc), intestines, etc. The yeasts live there in balance with the bacteria that are also naturally there. These bacteria ensure that there is just enough food for the yeasts, so that their number remains small. In Normal comdition we don't notice any of it and they don't do any harm.

However, sometimes the Candida yeasts can greatly expand, causing a candida infection or candidiasis. Usually this occurs when our natural resistance is reduced for some reason, or when the balance between bacteria and yeasts is disturbed (e.g. during an antibiotics treatment).
A Candida infection is usually quite harmless and can usually also be treated quite well. In exceptional cases, it can be dangerous when Candida enters the blood and causes a generalized infection or 'systemic candidiasis'. This form of a Candida infection occurs only in seriously ill people with severely reduced resistance. For example, in people who have undergone an organ transplant, in cancer patients after chemo or in Aids patients.

Risk factors

Multiple factors can play a role in the onset of a Candida infection.

• A moist environment stimulates the multiplication and spread of all yeasts and fungi.
• Antibiotics also destroy the beneficial bacteria in and on the body. When these bacteria are thinned out, Candida is more likely to multiply and spread.
• People with a weak or weakened immune system are particularly sensitive. This is particularly true for premature and very young babies, HIV patients, the elderly, people who take chemo and those who have had organ transplants and should take immunosuppressant drugs.
• Diabetes that is not well controlled.
• Chronic diseases, through a combination of risk factors.
• There may also be genetic factors that make someone more susceptible to a Candida infection.
• Hormonal factors: vaginal candidasis are facilitated by pregnancy, contraception, and estrogen treatment. Some women often get a yeast infection around menstruation, others during pregnancy.
• Multiple or frequently varying sexual contacts and oral sex might increase the risk of vaginal Candida infection.
• Thrush (Candida infection in the mouth) can be facilitated by the use of medicines that are inhaled (e.g. in asthma).
• Eating a lot of carbohydrates or sugars could in theory promote candidiasis, because yeasts live on sugar. But there is still a lot of ambiguity about the exact (causal) link between a sugar-rich diet and a Candida infection.

Is Candida contagious?

Candida yeasts occur naturally on the skin, on mucous membranes of mouth and vagina, among other things. Although the yeast can be transferred from one person to another (e.g. from mother to child or vice versa, between sexual partners), it is not really an infection in the traditional sense of the word. Candida is therefore not considered an infectious disease and certainly not as a sexually transmitted disease.

The partner of someone with a vaginal candidiasis should therefore not be treated unless he or she is also infected and has symptoms.
In babies with thrush or when a breastfeeding mother has a candida infection of the nipples, both mother and child should be treated because they can pass the infection to each other.

Where can a Candida infection occur?

Candida infection can occur in different parts of the body.

• On the skin
  Candida albicans survives well on a moist, soaked skin, and especially in skin folds (e.g. in the groin, under the breasts or armpits).
  Babies can get a Candida infection on top of a regular diaper rash.
  Nails can also become infected with candida. This is especially common in people who work a lot with sugars professionally (e.g. bakers, cooks) or who often have wet hands.
• On the nipples
  In breast-feeding women, a Candida infection may occur on the nipples.
• In the mouth
  About half of the population would naturally have (commensal) Candida in their mouths, without any discomfort. But sometimes this can give rise to an infection. Candidiasis or thrush occurs in people with weakened immunity (e.g. cancer or Aids patients), after treatment with antibiotics or chemotherapy, in premature hours, inhalation of corticosteroids (e.g. in asthma), intubation (during surgery or when you are on intensive care for a long time). Even if you produce too little saliva and have too dry a mouth, it can occur. For example, when you are irradiated there. Saliva helps to maintain the balance in the mouth.
  Thrush may also be the result of a poorly seated tooth prosthesis. The prosthesis softens the gums locally and closes it off from the air.
  Babies can become infected with Candida in the birth canal, but also through the hands of other caregivers.
  
  
  Perlèche
  Perlèche is a usually persistent eczema-like inflammation of the mouth corners that arises from irritation by saliva. Often there is an infection with Candida albicans on top. Typical features include redness and flaky, soft skin. In a Candida infection, there is usually a white flake to be seen. Young children can get perlèche by drooling and munching. In children with a large tongue (as with Down syndrome) this is common. In older people, it can be a result of poorly seated dentures or the incursion of the cheeks.
  
  
• In de vagina (vulvovaginale candidiasis)
  Candida is the leading cause of vaginal infections. Most women experience at least one vaginal Candida infection during their lifetime, e.g. during pregnancy. In some women, this can occur repeatedly. A vaginal candida infection can occur when the balance between bacteria and Candida in the vagina is disturbed. Especially in the second half of the menstrual cycle, during pregnancy and in diabetes, the vagina contains a higher sugar content from which the candida yeast benefits. The vagina can also be infected from the outside (e.g. through toilet paper or a washcloth previously used for the anus). Genital Candidiasis or vaginitis is not a sexually transmitted disease (STD). Your partner should not be treated, unless he also has complaints.
  
  
  Repeated vaginal infections
  It is estimated that about 5% of all women would get a vaginal Candida infection over and over again. When this occurs more than 4 times a year, one speaks of a recurrent vulvovaginal candidiasis. Why this happens to some women is still not entirely clear.
  
  Possible factors that encourage this
  • Poor adherence to previous treatments (not treated long enough).
  • Oral contraceptive pills with more than 30
  • Overweight
  • Sexual activity (especially oral sex: mouth is an important candida reservoir)
  • Excessive vaginal "hygiene"
  • Diabetes
  • Immune disorders (corticoids, chemotherapy, AIDS...)
  • An infection with a different form than Candida albicans (Candida tropicalis and Candida glabrata).
    With repeated vaginitis, the doctor will always check whether it is indeed a candida infection. Vaginitis can also be a result of, for example, contact dermatitis (soap, deodorant, underwear, etc.).
  
  
• Penis (Balanitis)
  In men, the penis can become infected by Candida yeasts.
• In the intestines?
  Candida albicans lives in the intestines where it is harmless. Whether this can also give rise to symptoms such as diarrhoea after antibiotic use, and whether this should be treated, is controversial.
• Internal
  After a medical procedure, a Candida infection can occur in various organs.
  For example, if the intestinal membrane is damaged by repeated bowel surgeries, or if you have a catheter for probe feeding for days. These systemic infections occur mainly in kidneys, heart, liver, central nervous system, lungs, spleen and deeper tissues of the digestive system. This is serious and needs to be treated with powerful medicines.

Complaints

• Affected skin looks fire-red. Small, fluid-filled vesicles may occur. If the nails are damaged (Candida-paronychia), the nail bed is affected. The nail bed can be red and painful, the nails can turn white or yellow and welds.
• Infection of the mouthcosa (thrush) shows a whitish, sometimes painful rash on the tongue and mucous membranes of the cheeks and palate. The mucous membranes themselves are inflamed red. Thrush can spread to the throat and esophagus where it causes a nuisance pain and sores.
  Babies who drink restlessly, repeatedly release their chests or refuse the breast may have thrush.

Candida on the mouth

• At Perlèche, gaps form in the corners of the mouth.
• In the case of a candida infection of the nipples they look shiny pink to red, with sometimes white dots or flakes. Sometimes gaps arise. It is usually accompanied by a stinging pain that radiates from the nipple to the chest, and which can persist long after breastfeeding.
• With candida-vaginitis or vaginal candidiasis, the skin around the sheath can turn red and often causes severe itching and burning sensation.
  Also, the labia may be red and swollen. An increase in vaginal discharge (fluorine vaginalis) may occur. The secretion is often grainy and white, like crumbly cheese, but odorless. Peeing and making love can be painful.
• With a candida infection of the penis, the acorn can look red and flaky, very itchy and hurt when touching or when making love.
• The symptoms of a generalized candidiasis are not always very clear because these people are often already very sick and already have a high fever.
  How is the diagnosis made?
  The appearance of the affected skin or mucous membranes sometimes makes it immediately clear to the doctor what it is about. If in doubt, a sample will be examined under the microscope or in the lab.
  If you suspect a generalized Candida infection, a specialized blood test will usually be carried out.

What can you do to prevent a (new) Candida infection?

• In infants, good hygiene is particularly important. If you are breastfeeding it is wise to wash hands and nipples for each diet with lukewarm water.
• Teats or nipples (from bottles) are best boiled daily and stored in a dry and clean place.

• Use as little soap as possible or use only sour soap (soap with a Ph acidity below 7).
• Replace nursing pads after each feeding. Cotton nursing pads should be boiled for 5 minutes after use.
• Wash your bra at 60 °C and wear a clean-washed bra every day.
• Let your nipples air dry well after feeding. In case of a fungal infection, avoid massaging a drop of breast milk on the nipple.

• Wash your vagina not with soap, as this disturbs the natural acidity of your vagina. Preferably use lukewarm water.
• Do not use disinfectants such as Isobethadine soap, even during infections. Do not use vaginal showers and the like.
• When making love, make sure that the lining of the vagina is not damaged: if necessary, use a lubricant.
• Oral sex could potentially increase the risk of a vaginal infection.

• Keeps your skin clean and dry. Gently pat the skin dry, rather than rubbing hard.
• Use as little soap as possible.
• Use talcum powder in skin folds and babies to absorb the moisture.

Treatment

candida on hands

A candida infection is usually quite harmless and more annoying than dangerous. The infection often disappears spontaneously after several weeks. But in some cases, it can be persistent or come back repeatedly. Treatment is only necessary when the complaints are annoying or always return. In case of severe or repeated Candida infection, the doctor will always check the exact Candida type and possibly check previous treatments in order to be able to set the appropriate treatment. Always follow the prescribed dose and method of administration – ask your doctor if necessary – and complete the prescribed course of treatment.

• Skin infection
  For a superficial infection of the skin, treatment with a drying product such as Eosine is usually sufficient.
  Talcum powder can also help. That doesn't do anything against the yeast itself, but on dry skin the yeast can not expand.
  In case of more persistent complaints, the doctor may prescribe a skin cream or ointment against fungi and yeasts such as nystatin (magisterial preparation by the pharmacist), Miconazol (brand name: Daktarin) or clotrimazole (brand name: Canestene). In case of a serious infection and damage to the nails, an oral medicine to be taken is also likely to be required.
  In diaper dermatitis, the doctor may prescribe a combination product of miconazole with zinc oxidis (Daktozin).
• Mouth infection
  Candida of the mouth can be well treated with medicines. A treatment with mouthwash or oral gel based on miconazole (Dactarin gel) or nystatin will suffice. In young children (from 4 months onwards) miconazole is preferred. The product is given after the feeding. The gel is spread in the mouth with the finger or cotton swab. The product should be kept in the mouth for as long as possible (at least a few minutes) The treatment should be continued until 2 days after the rash has disappeared. In the case of severe or persistent infection, the doctor may prescribe systemic treatment with fluconazole pills (Candizole, Diflucan, Fluconazol generic product) or itraconazole (Sporanox, Spozole, Itraconazol generic product).
  Treatment will need to continue for 7 to 14 days.
  Gentiaan violet is no longer recommended due to the discoloration of the mucous membranes.
  Of course, the causes must also be addressed (e.g. poorly seated teeth, take out dental prosthesis at night, good oral hygiene, etc.
• Nipple infection
  In most cases, a treatment with a antifungal ointment based on miconazole (Dactarin) or nystatin will be prescribed.
  These products can also be used during breastfeeding.

Treatment of Candida vaginitis

Treatment depends on the severity of the infection and whether or not it is a recurrent infection.

• Acute infection
• In the case of acute infection, due to safety reasons, preference is usually given to a locally applied antifungal product based on clotrimazole (Canestene) or miconazole (Gyno-Daktarin).
  Localised treatment may also give slightly faster relief of the symptoms than whether to take pills orally.
  These products exist in ovules, cream or vaginal tablets. Place the product in the vagina before you go to bed. The vaginal cream has a special disposable applicator. This allows you to put the cream deep into the vagina. For this, it is best to lie on your back with curved, spread legs. Then bring the cream-filled applicator deep into the vagina, empty the applicator (by pressing) and dispose of it. The ovules can be inserted with your finger.
  Usually a one-day treatment with a high-dose ovule is sufficient. With a serious infection, longer treatment (one to two weeks) may be required.
  During pregnancy and breastfeeding, only localised imidazole derivatives are preferred, preferably miconazole (Gyno-Dactarin), and this for one week.
  
• Oral treatment with pills based on itraconazole (brand name Sporanox or generic product Itraconazole) or fluconazole (brand name: Diflucan, Candizole or generic product Fluconazole) is recommended when local treatment has failed. Because a pill is easier than an ointment, some women also prefer such treatment.
  During pregnancy, these products are better not given, although there is no direct evidence that they are harmful. During breastfeeding, Fluconazol can be given, intraconazole better not because it can pass into breast milk.
• A combination of localised and oral medicines is not recommended.
• Repeated infections
  Repeated infections (four or more times a year) are more difficult to treat.
  A long-term treatment (ten to fourteen days or more) may be required. Preference is a medicine taken by mouth.
  It is important that the treatment is maintained until all complaints are gone. If one stops too early, the infection will return, and other candida types may also occur.
  It will also look at factors that encourage the infection and, if possible, the necessary measures will be taken (e.g. better control of diabetes, another contraceptive pill, other antifungal medicines, etc.).
• The doctor may prescribe a preventive treatment in which a tablet fluconazol or itraconazole should be taken for three to six months once a week or a month (just before or at the end of
• The use of ketoconazole tablets (Nizoral) in regularly recurrent Candida infections is not recommended due to a high risk of liver damage.
• Treatment of the partner(s) is only necessary if they also have (have) complaints.
• During treatment it is better not to use tampons and refrain from having sex.
• Baths with 'baking soda' (NaCO3) (1 tablespoon per centimeter of water) and (cooled) wet tea bowls or olive oil can help against the itching and burning sensation.
  
• Rubbing the vagina and labia with gentian violet solution against the itching is not recommended. It causes a purple discoloration of body parts, clothing and bedding
• Polyvidon jew and hydrogen peroxyde do not help and can irritate, and are therefore discouraged.
• Rinsing with a lactic acid solution (Lactic acid solution 2%, Lactacyd) or inserting lactic acid ovules to acidify the vagina has little effect.
  The introduction of yoghurt tampons is also not recommended.
  Caution! Because certain (fatty) ingredients in the creams and vaginal tablets can affect the rubber of condoms and pessaries, these contraceptives are not safe up to three days after the cessation of treatment.
• Penis
  As with a vaginal infection, the doctor may prescribe an antifungal ointment or cream (imidazole) to apply to the penis. Twice a day for one to two weeks is usually sufficient.
  Because certain (fatty) ingredients in the creams can affect the rubber of condoms and pessaries, these contraceptives are not safe up to three days after the cessation of treatment.
• Diets
  There are several diets that are falsely claimed to be able to fight or prevent an infection with Candida. According to the scientific literature, diets do not affect an infection with Candida albicans. So-called 'anti-candida diets' can cause or aggravate complaints, because they contain, for example, little or small fruit and milk products. As a result, a shortage of fibre, vitamins and minerals may eventually arise.
• Probiotics
  Probiotics can be useful to help protect good bacteria in the intestines during a course of antibiotics. But it has not been demonstrated that they can prevent Candida's development.
  Probiotics would also increase the effectiveness of oral antifungal products (such as fluconazole) in vaginal candida infections, among other things.