Vaginal Candidiasis

Question 1

What are some predisposing factors for vaginal candidiasis?

Answer 1

• Diabetes mellitus
• Drugs: Antibiotics, steroids
• Pregnancy
• Immunosuppression: HIV, iatrogenic

Question 2

What investigations should be done if vaginal candidiasis is suspected?

Answer 2

Investigations are not usually needed.

But if recurrent vaginal candidiasis consider a High Vaginal Swab. (HVS)

Question 3

What is the management for vaginal candidiasis?

Answer 3

• Local treatments - clotrimazole pessary (e.g. clotrimazole 500mg PV stat)
• Oral treatments -
  
  • Itraconazole200mg PD BD for 1 day
  • Fluconazole 150mg PO stat

Question 4

How do you treat vaginal candidiasis in a pregnant woman?

Answer 4

Local treatments

Oral treatments are contraindicated

Question 5

What lifestyle factors should you give for someone with vaginal candidiasis?

Answer 5

Avoid tight fitting clothes

Topical or oral probiotics have little evidence but can consider it as a treatment adjunct.

Question 6

If someone has recurrent vaginal candidiasis (Candida albicans species)

what treatment should you offer?

Answer 6

6 month course of weekly intravaginal clotrimazole

or

Oral fluconazole

Question 7

If the HVS grows a non-albicans species (e.g. C. glabrata, C. rugosa)

What should you do as a GP and why?

Answer 7

Seek specialist advice/ Consider referral.

Non-albicans species are often resistant to standard treatment with imidazoles or they require prolonged treatment.

Question 8

What % of women with recurrent thrush infections are infected with non-albicans species?

Answer 8

20%