Introduction
Vaginal candidiasis ('thrush') is an extremely common condition which many women diagnose and treat themselves. Around 80% of cases of Candida albicans, with the remaining 20% being caused by other candida species.
Epidemiology
- Incidence: 4000.00 cases per 100,000 person-years
- Peak incidence: 30-40 years
| Condition | Relative incidence |
|---|---|
| Bacterial vaginosis | 1.25 |
| Vaginal candidiasis | 1 |
| Trichomonas vaginalis | 0.25 |
| Atrophic vaginitis | 0.25 |
| Lichen sclerosus | 0.03 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Aetiology
The majority of women will have no predisposing factors. However, certain factors may make vaginal candidiasis more likely to develop:
- diabetes mellitus
- drugs: antibiotics, steroids
- pregnancy
- immunosuppression: HIV, iatrogenic
Clinical features
Features
- 'cottage cheese', non-offensive discharge
- vulvitis: superficial dyspareunia, dysuria
- itch
- vulval erythema, fissuring, satellite lesions may be seen
Investigations
Investigations
- a high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis
Management
Management
Recurrent vaginal candidiasis
- options include local or oral treatment
- local treatments include clotrimazole pessary (e.g. clotrimazole 500mg PV stat)
- oral treatments include itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat
- if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated
Recurrent vaginal candidiasis
- BASHH define recurrent vaginal candidiasis as 4 or more episodes per year
- compliance with previous treatment should be checked
- confirm the diagnosis of candidiasis
- high vaginal swab for microscopy and culture
- consider a blood glucose test to exclude diabetes
- exclude differential diagnoses such as lichen sclerosus
- consider the use of an induction-maintenance regime
- induction: oral fluconazole every 3 days for 3 doses
- maintenance: oral fluconazole weekly for 6 months