This is a common condition usually caused by the yeast candida albicans. Predisposing factors include antibiotics, pregnancy and poorly controlled diabetes. However, the most common cause is use of soap based perfumed body washing products.
Main symptoms and signs are:
- Vulval itch, burning, erythema and sometimes fissures
- A curdy white non-odorous discharge
Examination: Not always necessary if typical symptoms.
Investigations: not necessary unless diagnosis is unclear, or recurrent symptoms:
- HVS or patient self-taken low vaginal swab: yeasts on microscopy and culture.
Treatment: please see formulary advice.
- Note that for severe infection, what can help is either Fluconazole 150mg or Clotrimazole 500mg pessary on day 1 and again on day 4.
- Partner treatment is only necessary if symptomatic.
- Do not use oral therapies in pregnancy.
Information to be given to patient:
- Caused by an overgrowth of Candida species, which are a bowel commensal.
- Treating partner does not improve outcomes
- May recur.
- See genital skin washing advice leaflet– and follow that advice to reduce recurrence rate.
- Switch to a soap substitute to wash the entire body – not just the genital skin and avoid all products in bath water including shampoo
- Stop fabric softener, wet wipes, feminine hygiene products, douching etc.
Recurrent Vulvovaginal Candidiasis:
This is defined as a failure of symptoms to resolve with treatment, or recurrence of symptoms after a very short time.
Management:
It is essential that women ensure they are following the genital washing advice information to the letter. Exclude all predisposing products.
Treatment: Requires induction and maintenance
Induction:
Fluconazole 150 mg orally every 72 h 3 doses or Clotrimazole 500mg pessary for up to 14 nights
Maintenance:
Fluconazole 150 mg orally once a week or Clotrimazole pessary 500 mg intravaginally once a week for six months.
This should be stopped after 6 months, and the situation reviewed. If symptoms recur consider referral to GUM after discussion about washing practices.
Non-albicans Candida species and azole resistance
Recommended regimen:
Nystatin pessaries 100,000 units intravaginally at night for 12–14 consecutive nights.
Nystatin can also be used to manage recurrent candida infections by using pessaries for 14 nights monthly for 6 months.
Note: All these regimes are empirical and can be adapted for the individual patient.
