- Symptomatic Candida infection occurs in 75% of women at some stage in their life
Treatment can be topical or oral anti-fungals – but be wary about the use of oral agents as they are not safe in pregnancy.
- 95% of cases the result of Candida albicans
- 5% of cases due to Candida Glabrata – which is more difficult to treat
- About 1/3 of chronic cases are due to non-albicans species
- Antibiotic use
- ALWAYS perform urine dipstick on a female patient presenting with thrush
- Not usually sexually transmitted – but can be – check that the partner is not affected before treatment to avoid re-infection.
- A white discharge, often described as clotted cream / cottage cheese, usually non-offensive
- Itchy and sore vulvar area
- The partner is usually asymptomatic, although sometimes candidal infection can cause balanitis in men
- Speculum and inspection
- Vulval and vaginal appearance:
- Sore, red
- Vaginal may be hyperaemic (red) and oedematous
- Vaginal pH – <4.5 (not always)
- Triple swabs and smear (chlamydia, gonorrhoea, and a ‘general’ swab for culture)
- Microscopy – will show budding yeast spores
- Culture – to rule out other causes
- Clotrimazole – can be given as a cream and/or pessary. Similar cure rates to a single oral dose of fluconazole
- 2% cream nightly for 3 nights, or 1% cream nightly for 7 nights
- Fluconazole – single oral dose – 150mg
- This is strongly contraindicated in pregnancy and thus ensure patient is not pregnancy before prescribing
- If infective agent is C. Galbrata – more difficult to treat. Try:
- Topical Nystatin
- Oral Imidazole – 7-14 days
- BREASTFEEDING / PREGNANCY – USE TOPICAL TREATMENTS ONLY
- Recurrent infection – may require maintenance dose
Chronic or recurrent vulvovaginal candidiasis occurs in a number of cases. It is thought to be due to a hypersensitivity to colonising candida, rather than true recurrent infections.
Typically patients have a reduction in symptoms whenever anti-fungals are used, but the relief is temporary. This should also prompt the clinical to consider alternative diagnosis too!
If chronic candidiasis is suspected, try suppression treatment, e.g.:
- Fluconazole 150mg PO daily for 3 days, then weekly for 6 months
- Treatment often has to continue for longer than 6 months
- If there is no improvement of symptoms after 6 months, consider an alternative diagnosis
- Can lead to chronic vulval pain, which may respond to treatments for chronic pain, particularly those for neuropathic pain, such as amitriptyline, gabapentin and pregabalin
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy