Vulvar and vaginal tinea (tinea genitalis, ringworm)

Vulvar and vaginal tinea (vaginal ringworm) is a common skin infection, but an emerging vulvar or vaginal complaint.

Tinea can also appear on the body and limbs, and is found worldwide, but is most common in tropical areas where it’s warm and moist. Tinea isn’t just found on the feet (athlete’s foot) or crotch (jock itch).

When tinea is found on the vulvar and in the vagina, it could be called vulvar or vaginal tinea, genital tinea, or tinea genitalis.

Symptoms of vulvar or vaginal tinea

• Sharply-edged scaly plaques or pustules in the genital region
• Red, spread concentrically (in circles)

Vulvar or vaginal tinea as a sexually transmitted infection

Some cases of vulvar or vaginal tinea appear to be sexually transmitted, though it doesn’t meet the criteria to be labelled as such. Vulvar and vaginal tinea are not a ‘primary’ sexually transmitted infection (officially classified as such), but vulvar and vaginal tinea can be sexually transmitted through touch, just like it can be passed on by feet in showers.

What causes vulvar or vaginal tinea? There are a few specific fungi that cause vulvar or vaginal tinea, with the primary culprit being Trichophyton interdigitale (formerly Trichophyton mentagrophytes). This fungus is the second most common pathogen in the world. Infection is called dermatophytosis or, more commonly, ringworm.

A dermatophyte is a pathogenic fungus that grows on skin, mucous membranes, hair, nails, feathers, and other body surfaces.

Transmission of vulvar and vaginal tinea

Transmission of the fungus that causes vulvar and vaginal tinea is made by human-to-human, animal-to-human, and soil-to-human contact. There are different names for tinea depending on where it appears, but the main fungus is generally the same.

Specific cases in one study show that the vulva and vagina were affected first before it spread to other areas. These cases were all observed after having protected sexual (using condoms) intercourse in South East Asia.

The people with the most severe inflammation shaved the genital area. Shaving is thought to disrupt the hair follicles, allowing the fungus to prosper and the infection to go deeper into the skin.

These people had worse outcomes of vulvar or vaginal tinea because of shaving. Anyone having sexual intercourse in South East Asia is at risk.

Strains of vulvar or vaginal tinea

The particular types of fungus found in six of the studied patients was zoophilic – meaning, having a preference for animals. These particular strains provoke a severe and sudden inflammatory reaction in humans, and treatment periods for these people was at least five weeks.

Some were left with very bad scarring. Some other zoophilic strains of T. interdigitale found to infect genitals in at least one case each have been T. erinacei, T. verrucosum, and T. mentagrophytes, spread from cattle and a dog.

Treatment of vulvar or vaginal tinea

Antifungals, either topically or systemic (through the blood) are used to treat these types of infections, plus steroids topically or systemically (use of topical steroids by themselves is not recommended).

Treatment times vary depending on the person. Antifungal itraconazole twice daily (either 100mg or 200mg) orally is a common treatment. 

An inflammatory reaction after commencing antifungal treatment is common, and will require systemic prednisone, a synthetic cortisone (steroid). To avoid irreversible scarring, identification and treatment need to be prompt.

Differential diagnoses of genital tinea

Clinical diagnosis of tinea genitalis can be problematic – the lesions can be seen as bacterial folliculitis, eczema, or genital psoriasis. Scarring can be very bad, so it’s important to identify and treat the fungus quickly.

Condoms do not prevent the spread of genital tinea.

Treating genital tinea at home using natural treatments/home remedies

Because of the potential for scarring from genital tinea, it can pay to seek medical treatment sooner rather than later. However, this doesn’t mean you can’t try some classic remedies for tinea, like Australian or New Zealand tea tree essential oil.

The oil of Melaleuca alternifolia is known to have potent antimicrobial effects, and can be applied diluted with another carrier oil to affected skin. Apply to skin multiple times per day.

If symptoms don’t start to reduce within 24-48 hours, seek medical advice.

References

Luchsinger I, Bosshard PP, Kasper RS, Reinhardt D, Lautenschlager S. Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature. Sex Transm Infect. 2015;91(7):493-6.