Vaginal Candiasis

Question 1

cause

Answer 1

Candida albicans

Question 2

risk factors

Answer 2

diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV

Question 3

features

Answer 3

‘cottage cheese’, non-offensive discharge
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen

Question 4

Ix

Answer 4

clinical

Question 5

Mx

Answer 5

oral fluconazole 150 mg as a single dose first-line

clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated

If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal

if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

Question 6

recurrent candida

Answer 6

more than 4

HV swab

blood glucose test - r/o dm

exclude lichen sclerosis

consider:

induction: oral fluconazole every 3 days for 3 doses

maintenance: oral fluconazole weekly for 6 months