Candidiasis Flashcards
Candidiasis is infection with ______ caused by _________
Infection with Candida species, caused by an overgrowth of the organisms often present in small amounts in the genital tract
What is the usual organism that causes candidiasis?
Candida albicans
Is candidiasis considered to be an STI?
No
What causes candidiasis?
Often no clear cause but some risk factors have been identified
Risk factors for candidiasis include…
Abx use (within past 3m)
Poorly controlled diabetes
Increase in oestrogen (exogenous or endogenous) including pregnancy, MHT and possibly COC
Skin conditions e.g. eczema or dermatitis
Immunosuppression
Candidiasis may cause _________ in males, especially if __________
May cause balanitis, especially if uncircumcised
Presentation of vulvovaginal candidiasis infection
White ‘curd like’ vaginal discharge
Genital or vulval itch, discomfort
Superficial dyspareunia
External dysuria
Excoriation, erythema, fissures, swelling
Is discharge always abnormal with candidiasis?
No, can appear normal
Presentation of penile candidiasis infection
Red rash on genitals, especially under foreskin (may or may not be itchy)
Swelling of foreskin if severe
Fissures
Superficial erosions
How common is candidiasis in women?
~75% women will experience at least one lifetime episode
_____ % of women will have recurrent candidiasis
<5%
Recurrent candidiasis defined as…
4 or more symptomatic episodes within 12 months
Indications for testing for candidiasis
Vaginal discharge
Vaginal odour or itch
Genital discomfort
Superficial dyspareunia
Genital rash, erosions or fissures
Should you test asymptomatic people for candidiasis?
Routine screening in asymptomatic people is not recommended
Why is examination recommended for candidiasis?
Exam is recommended for thorough assessment as symptoms are non-specific and may be due to other conditions such as dermatitis or genital herpes
What can you do if examination is declined?
Self-collected swabs can be done if exam is declined, but this is not recommended
Should you also check for STIs?
STIs symptoms are similar to those of candidiasis. Unless STIs have been excluded, testing should occur as part of a full sexual health check
Recurrent candidiasis should be confirmed by ___________ before considering suppressive therapy
Culture or microscopy on at least 2 occasions
Recommended test for vulvovaginal candidiasis
High vaginal swab for Candida and BV
________ is another common cause of unusual vaginal discharge
BV
Other tests to consider
Vulvovaginal NAAT swab for chlamydia, gonorrhoea and trichomoniasis
HIV and syphilis serology if STI testing indicated
Recommended tests for penile infection
Usually diagnosed based on signs and symptoms but can do culture swab for yeast
People with confirmed recurrent candida balanitis should be screened for ________
Diabetes
People with recurrent candida balanitis should discuss…
Status of their sexual partner(s) should be discussed (often occurs in the context of untreated recurrent vulvovaginal candidiasis in the partner)
Should you treat asymptomatic people?
No
Only treat symptomatic people
What’s more effective - oral or topical treatments?
Topical and oral azoles have a similar efficacy
Although not specifically recognised as risk factors people with recurrent candidiasis may benefit from avoidance of…
Perfumed products and tight clothing that promotes excessive sweating e.g. wetsuits, synthetic underwear
If breakthrough symptoms on suppressive therapy occur…
Confirm ongoing candida before changing treatment regimen.
Request culture swab for speciation and sensitivities, and write ‘breakthrough symptoms while on suppressive therapy’ on the request form
Recommended treatment for acute vulvovaginal candidiasis
Clotrimazole 2% vaginal cream, one vaginal applicator every night for 3 days
OR
Fluconazole 150 mg orally, as a single dose
Alternative treatment for acute vulvovaginal candidiasis
Nystatin vaginal cream, one applicator 1-2 times daily for 2 weeks
OR
Miconazole 2% vaginal cream, one vaginal applicator every night for 7 days
Recommended treatment for acute penile candidiasis
Clotrimazole 1% topical cream twice daily for 5-7 days
Alternative treatment for acute penile candidiasis
Miconazole 2% topical cream twice daily for 5-7 days
Recommended treatment for recurrent vulvovaginal candidiasis
Induction with fluconazole 150 mg orally, every 72 hours for 3 doses, followed by maintenance with fluconazole 150 mg orally, weekly for 6 months
Alternative treatment for recurrent vulvovaginal candidiasis
Clotrimazole 2% vaginal cream one vaginal applicator every night for 3 days. Repeat every month for 6 months
What should you do if recurrent vulvovaginal candidiasis due to non-albicans species or resistant C. albicans
Seek specialist advice
General advice for management/vulval care
Avoid local irritants e.g. soaps, bath oils, body washes, bubble baths, spermicides, vaginal lubricants, vaginal hygiene products
Soap substitute for washing e.g. Sorbolene, Cetaphil, QV
Important advice in terms of contraception while on treatment for candidiasis
Latex condoms, diaphragms and cervical caps can be damaged by antifungal vaginal creams
Should you treat sexual partners?
Sexual partners only require treatment if symptomatic
Does diet/probiotics have an effect on candidiasis?
No strong evidence that specific diets or the use of probiotics influence the recurrence of candidiasis
Treatment in someone who is breastfeeding
Same as above
Treatment in someone who is pregnant
Fluconazole contraindicated, may need longer course of topical treatment
Is contact tracing required?
No
Is follow up required?
No (unless sx persist or recur)
No test of cure required
Referral to or discussion with a sexual health specialist is recommended for…
Persistent or recurrent candidiasis
Failure to respond to above treatment
Complicated clinical situations for further management
