Glycosuria in Pregnancy as a Predisposing Cause of Vaginal Thrush; with Special Reference to Its Importance in the Treatment of This Condition

INTRODUCTION: Attention is drawn to the fact that pregnancy and glycosuria are recognised to be predisposing factors in the causation of vaginal thrush. Confusion exists, however, as to the exact nature of the glycosuria associated with pregnancy. The critical and often serious glycosuria of diabetes mellitus in pregnant women is contrasted with the mild, transient and often symptomless glycosuria of pregnancy. The importance of a full understanding of this subject lies in this, that the treatment of the patient, with or without insulin, depends on it. PART I A REVIEW OF OUR KNOWLEDGE OF THE GLYCOSURIA OF PREGNANCY: The glycosuria of diabetes mellitus is not discussed, but attention is directed only to the transient glycosuria of pregnancy. Three rather ill-defined types are described: (1) early alimentary glycosuria; (2) renal glycosuria; (3) late alimentary glycosuria. The changes in the concentration of glucose in the blood and urine of groups of pregnant women when starved and later fed with a known quantity of glucose are narrated and compared with the changes in the blood and urine of non-pregnant women treated in the same way. An attempt is made to assess the incidence of glycosuria among pregnant women living on an ordinary diet. Very different estimates by a number of authorities are referred to and are explained, in part at least, as due to the time, in relation to a meal, when a sample of urine is collected and examined. The character, the quality and amount of the meal, as well as the method of detecting the glucose affects the finding, for the glycosuria of pregnancy is frequently intermittent. The conclusion is arrived at that from 20 to 30 per cent. of women during some part of their pregnancy excrete appreciable quantities of glucose in their urine. PART II DISCUSSES THE RELATIONSHIP BETWEEN GLYCOSURIA AND VAGINAL THRUSH, AND RECORDS THE EXAMINATION AND TREATMENT OF A SMALL NUMBER OF PATIENTS SUFFERING FROM THAT DISEASE: Glycosuria is found to be present in all cases of vaginal thrush if suitable arrangements are made to collect and examine samples of urine. The avidity or predilection of Oïdium albicans for moist acid surfaces soiled with glucose is referred to. The possibility that the blastospores of that fungus, which are produced in enormous numbers in infected persons, may be dispersed in the air of hospital wards containing cases of vaginal thrush is commented upon. The examination of the blood and urine while the patient is starving and after a feed of 50 grams of glucose in a small series of cases of vaginal thrush is recorded. The treatment of four cases as examples is detailed. The general conclusion is arrived at, on the basis of the established facts, that a well-balanced diet, with adequate vitamin content, must be regarded as an essential part of the treatment of vaginal thrush, in addition to the local application of antiseptics such as gentian violet or iodine. Careful and frequent examinations of the urine for the presence of sugar in samples collected after the main meal of the day and during the later stages of the pregnancy, and the correction of errors of diet revealed in this way, are prophylactic measures against thrush infection of the vagina of pregnant women.