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.


  • Incidence: 4000.00 cases per 100,000 person-years
  • Peak incidence: 30-40 years
Condition Relative
Bacterial vaginosis1.25
Vaginal candidiasis1
Trichomonas vaginalis0.25
Atrophic vaginitis0.25
Lichen sclerosus0.03
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+


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

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


  • a high vaginal swab is not routinely indicated if the clinical features are consistent with 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