Genital fungal infections
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Overview of Genital Fungal Infections: Epidemiology and Pathogens
Genital fungal infections are common in both men and women, though they are often underreported or misdiagnosed due to atypical symptoms and lack of awareness Jin2024Arıdogan2011. In men, infections are relatively rare but can present with diverse and mild symptoms, making diagnosis challenging Jin2024Arıdogan2011. In women, vulvovaginal candidiasis (VVC) is one of the most frequent causes of infectious vaginitis, with most women experiencing at least one episode in their lifetime Oriel1972d’Enfert2020.
The most common pathogens responsible for genital fungal infections are Candida albicans and, in men, Trichophyton rubrum Jin2024Oriel1972Gangiah2025+2 MORE. Other non-albicans Candida species and fungi such as Malassezia and Conidiobolus can also be present, especially in cases of bacterial vaginosis (BV) or altered genital microbiota .
Clinical Features and Diagnosis of Genital Fungal Infections
Male Genital Fungal Infections
In men, genital fungal infections typically affect the scrotum and penis, with lesions often appearing as erythematous, dry, scaly patches that may lack clear borders . Trichophyton rubrum is the leading cause, followed by Candida albicans . Diagnosis relies on a combination of medical history, clinical examination, and laboratory confirmation through microscopy and culture, as clinical presentation alone is often insufficient Jin2024Arıdogan2011.
Female Genital Fungal Infections
In women, VVC is characterized by itching, discharge, and irritation, but symptoms can overlap with other genital infections, making laboratory confirmation essential Oriel1972Gangiah2025d’Enfert2020. Candida albicans is the predominant pathogen, but non-albicans species are also implicated, particularly in recurrent or treatment-resistant cases Oriel1972Gangiah2025Sustr2020+1 MORE. Diagnosis should be confirmed by culture or molecular methods, as clinical signs alone are not reliable Gangiah2025d’Enfert2020.
Risk Factors and Predisposing Conditions
Several factors increase the risk of genital fungal infections. In men, predisposing factors include concurrent fungal infections elsewhere on the body (especially tinea cruris), use of corticosteroids, and high moisture environments . In women, risk factors include antibiotic use, hormonal changes, diabetes, and use of oral contraceptives Ono2019Oriel1972Gangiah2025+1 MORE. Treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitors for diabetes is associated with a higher risk of genital fungal infections, particularly in women and those with a prior history of such infections .
Sexual transmission of Candida is possible, especially with frequent anogenital or orogenital contact, and may contribute to recurrent infections . Circumcision has been noted to reduce the risk of male genital fungal infections .
Microbiome Interactions and Immune Response
The genital mycobiome is diverse, with Candida species dominating in healthy women, but shifts in bacterial communities (such as during BV) can alter fungal abundance Pekmezović2019Thong2018Sustr2020. Antibiotic treatment for BV can lead to a temporary increase in vaginal fungi, mainly Candida albicans, which is associated with increased genital inflammation and higher levels of proinflammatory cytokines Pekmezović2019Sustr2020. Dysbiosis, or imbalance in the genital microbiota, can promote overgrowth of pathogenic fungi and increase susceptibility to infection Thong2018Sustr2020.
Prevention and Management
Timely and accurate diagnosis is crucial for effective management of genital fungal infections Jin2024Arıdogan2011d’Enfert2020. Treatment typically involves antifungal medications, and addressing underlying risk factors such as moisture, diabetes, or inappropriate corticosteroid use is important for prevention Jin2024Ono2019d’Enfert2020. In recurrent cases, evaluation of sexual practices and partner treatment may be necessary .
Conclusion
Genital fungal infections are common and can affect both men and women, with Candida albicans being the most frequent pathogen. Diagnosis should be confirmed by laboratory methods due to the nonspecific nature of symptoms. Risk factors include antibiotic use, diabetes, corticosteroid application, and sexual behaviors. Understanding the interplay between the genital microbiome and fungal pathogens is essential for improving prevention and treatment strategies Jin2024Arıdogan2011Pekmezović2019+6 MORE.
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