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GPEP Sexual Health > Candidiasis > Flashcards

Candidiasis Flashcards

1
Q

Candidiasis is infection with ______ caused by _________

A

Infection with Candida species, caused by an overgrowth of the organisms often present in small amounts in the genital tract

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2
Q

What is the usual organism that causes candidiasis?

A

Candida albicans

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3
Q

Is candidiasis considered to be an STI?

A

No

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4
Q

What causes candidiasis?

A

Often no clear cause but some risk factors have been identified

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5
Q

Risk factors for candidiasis include…

A

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

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6
Q

Candidiasis may cause _________ in males, especially if __________

A

May cause balanitis, especially if uncircumcised

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7
Q

Presentation of vulvovaginal candidiasis infection

A

White ‘curd like’ vaginal discharge
Genital or vulval itch, discomfort
Superficial dyspareunia
External dysuria
Excoriation, erythema, fissures, swelling

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8
Q

Is discharge always abnormal with candidiasis?

A

No, can appear normal

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9
Q

Presentation of penile candidiasis infection

A

Red rash on genitals, especially under foreskin (may or may not be itchy)
Swelling of foreskin if severe
Fissures
Superficial erosions

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10
Q

How common is candidiasis in women?

A

~75% women will experience at least one lifetime episode

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11
Q

_____ % of women will have recurrent candidiasis

A

<5%

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12
Q

Recurrent candidiasis defined as…

A

4 or more symptomatic episodes within 12 months

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13
Q

Indications for testing for candidiasis

A

Vaginal discharge
Vaginal odour or itch
Genital discomfort
Superficial dyspareunia
Genital rash, erosions or fissures

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14
Q

Should you test asymptomatic people for candidiasis?

A

Routine screening in asymptomatic people is not recommended

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15
Q

Why is examination recommended for candidiasis?

A

Exam is recommended for thorough assessment as symptoms are non-specific and may be due to other conditions such as dermatitis or genital herpes

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16
Q

What can you do if examination is declined?

A

Self-collected swabs can be done if exam is declined, but this is not recommended

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17
Q

Should you also check for STIs?

A

STIs symptoms are similar to those of candidiasis. Unless STIs have been excluded, testing should occur as part of a full sexual health check

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18
Q

Recurrent candidiasis should be confirmed by ___________ before considering suppressive therapy

A

Culture or microscopy on at least 2 occasions

19
Q

Recommended test for vulvovaginal candidiasis

A

High vaginal swab for Candida and BV

20
Q

________ is another common cause of unusual vaginal discharge

A

BV

21
Q

Other tests to consider

A

Vulvovaginal NAAT swab for chlamydia, gonorrhoea and trichomoniasis
HIV and syphilis serology if STI testing indicated

22
Q

Recommended tests for penile infection

A

Usually diagnosed based on signs and symptoms but can do culture swab for yeast

23
Q

People with confirmed recurrent candida balanitis should be screened for ________

A

Diabetes

24
Q

People with recurrent candida balanitis should discuss…

A

Status of their sexual partner(s) should be discussed (often occurs in the context of untreated recurrent vulvovaginal candidiasis in the partner)

25
Q

Should you treat asymptomatic people?

A

No
Only treat symptomatic people

26
Q

What’s more effective - oral or topical treatments?

A

Topical and oral azoles have a similar efficacy

27
Q

Although not specifically recognised as risk factors people with recurrent candidiasis may benefit from avoidance of…

A

Perfumed products and tight clothing that promotes excessive sweating e.g. wetsuits, synthetic underwear

28
Q

If breakthrough symptoms on suppressive therapy occur…

A

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

29
Q

Recommended treatment for acute vulvovaginal candidiasis

A

Clotrimazole 2% vaginal cream, one vaginal applicator every night for 3 days
OR
Fluconazole 150 mg orally, as a single dose

30
Q

Alternative treatment for acute vulvovaginal candidiasis

A

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

31
Q

Recommended treatment for acute penile candidiasis

A

Clotrimazole 1% topical cream twice daily for 5-7 days

32
Q

Alternative treatment for acute penile candidiasis

A

Miconazole 2% topical cream twice daily for 5-7 days

33
Q

Recommended treatment for recurrent vulvovaginal candidiasis

A

Induction with fluconazole 150 mg orally, every 72 hours for 3 doses, followed by maintenance with fluconazole 150 mg orally, weekly for 6 months

34
Q

Alternative treatment for recurrent vulvovaginal candidiasis

A

Clotrimazole 2% vaginal cream one vaginal applicator every night for 3 days. Repeat every month for 6 months

35
Q

What should you do if recurrent vulvovaginal candidiasis due to non-albicans species or resistant C. albicans

A

Seek specialist advice

36
Q

General advice for management/vulval care

A

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

37
Q

Important advice in terms of contraception while on treatment for candidiasis

A

Latex condoms, diaphragms and cervical caps can be damaged by antifungal vaginal creams

38
Q

Should you treat sexual partners?

A

Sexual partners only require treatment if symptomatic

39
Q

Does diet/probiotics have an effect on candidiasis?

A

No strong evidence that specific diets or the use of probiotics influence the recurrence of candidiasis

40
Q

Treatment in someone who is breastfeeding

A

Same as above

41
Q

Treatment in someone who is pregnant

A

Fluconazole contraindicated, may need longer course of topical treatment

42
Q

Is contact tracing required?

A

No

43
Q

Is follow up required?

A

No (unless sx persist or recur)
No test of cure required

44
Q

Referral to or discussion with a sexual health specialist is recommended for…

A

Persistent or recurrent candidiasis
Failure to respond to above treatment
Complicated clinical situations for further management

GPEP Sexual Health (8 decks)

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