Genital Tract Infection - Candidiasis

Question 1

What is Vaginal Candidiasis?

Answer 1

Thrush - vaginal infection with a yeast of the Candida family - commonest : Candida albicans.

Question 2

Risk Factors of Vaginal Candidiasis (4).

Answer 2

1. Increased Oestrogen.
2. Poorly-Controlled Diabetes.
3. Immunosuppression (e.g. Steroids).
4. Broad-Spectrum Antibiotics.

Question 3

Pathophysiology of Vaginal Candidiasis (2).

Answer 3

1. Asymptomatic Colonisation.

2. Infection if Favourable Environment eg. Pregnancy, Treatment with Broad-Spectrum Antibiotics.

Question 4

Clinical Features of Vaginal Candidiasis (3).

Answer 4

1. Thick White Odourless Discharge : Cottage-Cheese.
2. Vulval and Vaginal Itching, Irritation or Discomfort.
3. Severe : Erythema, Fissures, Oedema, Dyspareunia, Dysuria, Excoriation.

Question 5

Investigations of Candidiasis (3).

Answer 5

1. Vaginal pH < 4.5 (Differentiate from Bacterial Vaginosis and Trichomoniasis).
2. Diagnosis : Charcoal Swab with Microscopy.
3. High Vaginal Swab not routinely indicated if clinical features consistent with Candidiasis.

Question 6

Management of Candidiasis (4).

Answer 6

1. Empirical Treatment.
2. Single Dose Antifungal Cream - Clotrimazole at Night.
3. Single Dose Antifungal Pessary - Clotrimazole. at Night or 3 doses over 3 nights.
4. Single Dose of Antifungal Tablets - Fluconazole 150mg.
5. Pregnancy - Oral Treatments are contraindicated.

Question 7

What OTC medication is available for vulval symptoms?

Answer 7

Canister Duo - Single Fluconazole Tablet and Clotrimazole Cream to use externally.

Question 8

Contraception and Antifungal Medications.

Answer 8

Antifungal Creams and Pessaries can damage latex condoms and prevent spermicides from working - extra contraception required for at least 5 days after use.

Question 9

Management of Recurrent Vaginal Candidiasis (5).

Answer 9

1. Induction and Maintenance with Oral Fluconazole every 3 days for 3 doses and weekly for 6 months.
2. Diagnose if 4+ episodes annually.
3. Check compliance with previous treatment.
4. High Vaginal Swab for MC&S and Blood-Glucose (Diabetes).
5. Distinguish from Lichen Sclerosus.