Candidiasis (Thrush) Flashcards
What causes vaginal candidiasis?
- it is a vaginal infection with a yeast of the Candida family
- the most common is Candida albicans
When does candida tend to cause symptoms?
- it can colonise the vagina without causing symptoms
- it progresses to infection when the optimum environment occurs
- e.g. during pregnancy
- or after treatment with broad spectrum abx that alter the vaginal flora
What are the risk factors for candida infection?
- high oestrogen (e.g. during pregnancy)
- poorly controlled diabetes
- immunosuppression (+ use of corticosteroids)
- broad-spectrum antibiotics
What are the symptoms of candidiasis?
- thick, white discharge that does not smell
- vulval / vaginal itching, irritation or discomfort
What can more severe candidiasis result in?
- dyspareunia
- erythema
- fissures
- excoriation
- dysuria
- oedema
When is treatment started for candidiasis?
usually treatment is started empirically based on presentation
What investigations may be performed?
vaginal pH:
- in candidiasis, the pH will be < 4.5
- in BV or trichomoniasis, the pH will be > 4.5
charcoal swab + microscopy:
- confirms the diagnosis
What is the treatment for candidiasis?
treatment involves anti-fungal medications that can be delivered in several ways:
- anti fungal cream (e.g. clotrimazole) inserted into the vagina with an applicator
- anti fungal pessaries (e.g. clotrimazole)
- oral anti fungal tablets (e.g. fluconazole)
What is the treatment recommendation if antifungal cream is being used?
a single dose of intravaginal clotrimazole cream at night
(5g of 10% cream)
What is the treatment recommendation if antifungal pessaries are being used?
- a single dose of clotrimazole pessary (500mg) at night
OR
- 3 doses of clotrimazole pessaries (200mg) over 3 nights
What is the treatment recommendation if oral antifungal medication is used?
a single dose of fluconazole 150mg
What is Canesten Duo?
- an over the counter medication
- it contains a single fluconazole tablet** and **clotrimazole cream to use externally for vulval symptoms
What advice needs to be given to women before prescribing antifungal creams or pessaries?
- they can damage latex condoms and prevent spermicides from working
- alternative contraception is required for at least 5 days after use