Understanding Candidiasis : Gui

de to Types, Symptoms, and Treatment

Candidiasis is a common fungal infection caused by an overgrowth of Candida species, most often C. albicans. While many people associate it with vaginal yeast infections, it is a condition that can affect various parts of the body, from the mouth and throat to the bloodstream. In Hong Kong's unique climate and healthcare environment, understanding the different forms of candidiasis—from common, easily treatable infections to serious, invasive threats—is crucial for effective prevention and management. This guide provides a comprehensive overview tailored for Hong Kong residents.

What is Candidiasis?

Candidiasis is an infection caused by yeasts from the Candida family. Small amounts of these fungi live naturally on our skin, in the mouth, digestive tract, and vagina without causing problems¹. They are kept in check by the body's healthy bacteria and immune system. However, when the balance is disrupted, Candida can multiply, leading to an infection with a range of symptoms.

This imbalance can be triggered by several factors common in Hong Kong lifestyles and healthcare settings, including the use of antibiotics, pregnancy, uncontrolled diabetes, a weakened immune system, and wearing tight-fitting, non-breathable clothing.

Common Types of Candidiasis and Their Symptoms

Candidiasis manifests differently depending on the infection site. The most prevalent forms in Hong Kong are mucosal infections.

1. Vaginal Candidiasis (Yeast Infection)

This is one of the most frequent types. Data indicates that a significant portion of local HIV-infected women have experienced vaginal candidiasis². It is common in women of childbearing age.

• Symptoms: Intense vulval itchiness, thick white "cheese-like" or "bean curd" discharge, vaginal soreness, redness, and discomfort or burning during urination or intercourse. Notably, many women carry the yeast without any symptoms and do not require treatment.
• Key Risk Factors in HK: Antibiotic use, pregnancy, diabetes mellitus, and a weakened immune system. Douching or using scented hygiene products also disrupts the vaginal environment and increases risk.

2. Oral Candidiasis (Thrush)

This infection appears in the mouth and is a well-known opportunistic infection, especially in individuals with compromised immunity.

• Symptoms: White, creamy patches on the tongue, inner cheeks, or throat that can be scraped off (leaving a red base), a burning sensation, or loss of taste. A related condition is angular cheilitis, causing cracks and redness at the corners of the mouth.
• Key Risk Factors in HK: It is a significant indicator for HIV disease progression and is most common when the immune system is severely suppressed. Use of steroid inhalers, dentures, and smoking are other contributing factors.

3. Invasive Candidiasis

This is a severe, systemic infection where Candida enters the bloodstream and spreads throughout the body. It is a major concern in Hong Kong's hospitals, particularly in Intensive Care Units (ICUs)³.

• Symptoms: Fever and chills that do not improve with antibiotics. Symptoms can become severe and lead to septic shock, affecting multiple organs.
• Key Risk Factors in HK: Patients with central venous catheters, those who have undergone major abdominal surgery, individuals with prolonged ICU stays, and those with weakened immune systems (e.g., from cancer chemotherapy) are at highest risk.

Candida Auris: An Emerging Threat in Hong Kong Healthcare

A particularly concerning type is Candida auris (C. auris), an emerging multidrug-resistant fungus identified as a serious global public health threat. It has caused outbreaks in healthcare facilities worldwide, including in Hong Kong.

• Why It's Dangerous: C. auris is often resistant to multiple antifungal drugs, is difficult to identify with standard lab tests, and can persist on surfaces in healthcare environments for long periods, leading to outbreaks.
• Transmission in HK Settings: It spreads primarily through contact with contaminated surfaces or equipment, and from person to person in healthcare and long-term care facilities. This makes strict infection control in local hospitals and homes critical.

Diagnosis and Testing in Hong Kong

Accurate diagnosis is essential, as symptoms can overlap with other conditions like bacterial vaginosis or trichomoniasis. Overprescription of antifungals is a noted issue in Hong Kong, highlighting the need for proper diagnosis before treatment.

• For Vaginal Infections: Diagnosis is often clinical. For persistent or unclear cases, a doctor may examine a sample of discharge under a microscope to look for yeast cells. pH testing can also help differentiate it from other vaginal infections.
• For Oral Infections: Typically diagnosed by visual examination. Scraping a lesion to see if the white plaque can be removed is a common check.
• For Severe or Recurrent Cases: Culture tests can identify the specific Candida species. In Hong Kong, private clinics offer DNA-based panels that can detect multiple species, including rarer ones, from urine or swab samples, with results in 8-24 hours. For invasive disease, blood cultures and tests for biomarkers like beta-D-glucan are used.

Treatment and Management

Treatment depends entirely on the type and severity of the infection.

• Vaginal Candidiasis: For symptomatic women, treatment includes antifungal vaginal pessaries (inserts), topical creams, or a single oral dose of fluconazole. Partners generally do not need treatment unless they are also symptomatic.
• Oral Candidiasis: First-line treatment is usually fluconazole taken orally for 7-14 days. For HIV-positive patients, successful treatment of the HIV infection with antiretroviral therapy is key to preventing recurrence.
• Invasive Candidiasis & C. auris: Requires immediate hospitalization and intravenous antifungal drugs. Echinocandins are a primary class of drugs used. Treating C. auris is challenging due to resistance, and may require high doses of multiple antifungals. A 2025 Hong Kong hospital study found that the overall appropriateness of systemic antifungal prescriptions needs improvement, underscoring the complexity of treatment.

Prevention: Practical Tips for Hong Kong Residents

• For General & Vaginal Health: Wear cotton underwear, avoid overly tight pants, and do not douche or use scented products in the genital area. After using the toilet, always wipe from front to back. Maintain good control of blood sugar if you have diabetes.
• To Combat C. auris in Healthcare Settings: Meticulous hand hygiene with alcohol-based rub or soap and water is paramount. In healthcare facilities, isolation precautions, cleaning surfaces with approved disinfectants (like diluted bleach), and using dedicated equipment for infected patients are standard protocols.

Where to Seek Help in Hong Kong

If you suspect you have a candidiasis infection, you can consult:

Private Doctors or Gynecologists: Many private clinics, such as women's health or sexual health clinics, offer confidential consultation, testing, and treatment.

Urban Medical provides professional consultation & medication and comprehensive candida DNA screening.

Hong Kong Public Health Services: The Department of Health's Social Hygiene Clinics provide examination, treatment, and counselling. No appointment or referral letter is needed, and services are confidential.

If you experience symptoms of invasive infection (like persistent fever while in hospital), inform healthcare staff immediately.

Ref:

1. Information on Vaginal Candidiasis, Family Health Service, Department of Health
2. CANDIDIASIS AND HIV, Kenny CW CHAN
3. Pang YK, Ip M, You JHS. Potential clinical and economic outcomes of active beta-D-glucan surveillance with preemptive therapy for invasive candidiasis at intensive care units: a decision model analysis.