Patients of Type I and Type 2 Diabetes are at a higher risk of developing infections. Some infections are exclusively found in diabetics while some others may be found to be recurrent or of elevated severity in diabetics. Many a times, it is found that “prutius vulvae” or “purutis scroti” I.e. the itching of the vulva (external part) of the female genitals) or scrotum is one of the presenting symptoms of diabetes.
Urinary tract infections are common in patients with uncontrolled diabetes, autonomic neuropathy (damage of nerves that control everyday functions like blood pressure, bladder voiding etc) and bladder obstruction. Many infections are asymptomatic and confined only to the bladder. These infections have a high recurrence rate in a diabetic due to the impaired immune response to bacteria.
Infections, if ignored and left untreated may cause serious complications. Invasion by Vaginal warts, herpes simplex virus 2 (HSV-2) and pelvic inflammatory disease may culminate in development of diabetic ketoacidosis in Type 1 diabetic.
A routine infection is generally treatable with conventional anti- fungal creams and broadspectrum antibiotics like Fluconazole while some resistant strains may require specific antibiotic medications. Passing RBCs and WBCs in the urine along with the presence of fever is usually indicative of tissue invasion.
Candidiasis is a common fungal infection of the vulva and perineum (area between the anus and the genitals), especially in diabetics. It is usually caused due to improper cleaning practices and inadequate hygiene. It can be treated with oral (tablets) or topical( locally applied) antifungal medications.
Some symptoms of a genito – urinary infection are :
Polyuria (frequent urination)
- Dysuria (painful urination)
- Decreased urinary continence
- Malodour: an unpleasant smell
- Pruritus: severe itching of the skin
- Vulvovaginitis: Vaginal discharge and intense itching
- Rashes
- Inflammation or red patches o n skin
- Thrush: infection
Under normal circumstance, the urino-genital tract has a healthy microflora and yeast that keeps our body safe from pathogenic microorganisms by fighting them. In addition to this, the leucocytes (WBCs) provide an excellent defence system and work to eliminate pathogens by digesting them or engulfing them and then destroying them.
Bacteria and yeast are able to thrive when provided with sugars. Even in presence of a normal microflora, elevated blood glucose levels provide substrate for growth of yeast and leads to infection. Chronic hyperglycemia I.e. blood glucose levels above 200 mg/dL may cause impaired response to bacteria, further encouraging pathogenic growth.
A bacterial infection may also be due to the use of certain anti-diabetic medications eg: SGLT-2 Inhibitors
A few precautions that can be taken in order to prevent any bacterial infections are as follows:
- Appropriate blood glucose control.
- Consumption of probiotics (either as yoghurt, probiotic drinks or pharmaceutical supplements).
- Adequate hydration (2.5-3 litres per day for an adult, while patients taking SGLT-2 Inhibitors must make sure to have at least 4 litres per day)
- Keep genitals clean and dry. Bacteria and fungi love moisture! Males must clean the area under the foreskin regularly as this can be a breeding ground for a varies species of bacteria.
- Wear clean, cotton underwear that allows air to pass through the cloth. Avoid wearing the same underwear for more than 16 hours. You may change it before going to bed.
- Avoid tight fitting garments, especially bottoms that sticks to the skin and causes irritation.
- Don’t wear sweat laden clothes. Bacteria revel in the environments that provide them warmth and moisture.
- Avoid using talcum powders that are heavily scented. While they do make you feel fresh and dry, it increases risk to developing ovarian cancer in women and may cause irritation and itching.
- After using the restroom, wipe the perineum from front to back, instead of the other way round. This decreases the risk of transmission of fecal bacteria tothe genital area.
- Washing hands after using the restroom is a must.
- Females must avoid using scented tampoons or feminine sprays. These products destroy the pH balance of the vagina and kill all the good bacteria while allowing bad bacteria to grow.
We all accept that Prevention is better than cure It is important to understand that the first and foremost preventive measure against genitorurinary infections is management of persistent hyperglycemia. Managing hyperglycemia considerably reduces the risk of developing such complications. This should be done by taking the prescribed medications, exercising regularly and developing healthy eating habits. These 3 components play an indispensable role in preventing these infections by ensuring management of blood sugars.
MD FICP FACP FACE (USA) PGDDM (UK)
Fellowship In Diabetes (India)
Senior Consultant, Diabetes & Thyroid Specialities Center