Diagnosis & Management:

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• Contents

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• Clinical assessment guidelines

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Diagnosis and management

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Vulvovaginal Candidiasis
Diagnosis and management

Diagnosis

Management

Health advice

Follow-up

Recurrent candidiasis

• Explain the nature of the infection and provide literature on candidiasis.
• Ensure that the patient is aware of the need for adequate hygiene and avoidance of potential irritants.
• Sexual transmission has negligible significance in the aetiology of vulvovaginal candidiasis. Sex partners do not need to be examined and treated.

Follow-Up

Nil. The patient should return for any other laboratory results.

Recurrent Candidiasis

Diagnosis

The occurrence of at least four mycologically proven symptomatic episodes of candidal vaginitis within 12 months, with the exclusion of other common vaginal pathogens.

Clinical Features

Identical to acute vulvovaginal candidiasis.

Management

Exclude associated factors such as pregnancy, uncontrolled diabetes mellitus, hormone therapy (including oestrogens or corticosteroids), HIV infection and repeated courses of broad-spectrum antibiotics.

Most sufferers of recurrent candida will already know about avoiding tight-fitting or synthetic underwear, and not using douches or vaginal deodorants.

Treatment

Suppressive prophylaxis using a long term maintenance regimen is needed. One of the following regimens is suggested:

clotrimazole 500 mg pessaries intravaginally at night, once weekly for six months

or

ketoconazole 400 mg orally daily for 5 days after the onset of menses, over a six month period

or

fluconazole 150 mg orally once monthly for six months

or

ketoconazole 100 mg orally daily for six months

Routine treatment of partners is unlikely to reduce recurrence rates.

Candidal Balanitis

This topic is covered elsewhere on the web site.

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