Obstetrics and Gynaecology

Question 1

What is vaginal candidiasis?

Answer 1

Also known as thrush
Extremely common
Around 80% of cases of Candida albicans, with the remaining 20% being caused by other candida species

Question 2

What are some of the predisposing factors for vaginal candidiasis?

Answer 2

Majority of women will have no predisposing factors
1. DM
2. Drugs: antibiotics, steroids
3. Pregnancy
4. Immunosuppression: HIV

Question 3

What are the features of vaginal candidiasis?

Answer 3

‘Cottage cheese’, non-offensive discharge
Vulvitis: superficial dyspareunia, dysuria
Itch
Vulval erythema, fissuring and/ or satellite lesions may be seen

Question 4

What investigations if any are needed for vaginal candidiasis?

Answer 4

Clinical
A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis

Question 5

What is the management for vaginal candidiasis?

Answer 5

First line: oral fluconazole 150 mg as a single dose
Second line: if oral therapy is contraindicated = clotrimazole 500 mg intravaginal pessary as a single dose
If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
In pregnancy oral treatments are contraindicated = only local

Question 6

What is recurrent vaginal candidiasis?

Answer 6

Four or more episodes per year

Question 7

What is the management for recurrent vaginal candidiasis?

Answer 7

1. Compliance with previous treatment should be checked
2. Confirm the diagnosis of candidiasis: high vaginal swab for microscopy and culture
3. Consider a blood glucose test to exclude diabetes
4. Exclude differential diagnoses such as lichen sclerosus
5. Consider the use of an induction-maintenance regime
   Induction: oral fluconazole every 3 days for 3 doses
   Maintenance: oral fluconazole weekly for 6 months