Candida – Vulvovaginal

Last updated 26.09.12

 

Index

 

Definition

-  Candidiasis effecting vagina +/- vulva

 

Features

-  Oral ingestion of candida albicans colonises intestines & perineum

-  Vaginal glycogen & oestrogen metabilses & products cause contact dermatitis

-  Oestrogen peaks during ovulation & in pregnancy

-  Levels low prepubescent, during lactation, menopause & with Depo Provera

 

Cause

-  Candida albicans 90%

 

Associated S/S

-  Vulval itch

-  Rash: erythema, fissuring, ulcers, satellite lesions

-  Vaginal discharge: cottage cheese like

-  Dysuria

-  Dyspareunia

-  Pregnancy

-  Neonatal candida (oral, vaginal)

 

Risk Factors

-  Broad spectrum Abx

-  DM, GDM

-  Immunosupression

-  Obesity & Immobilisation

-  Macerated & heated skin

-  Pregnancy

 

Ix

-  Vaginal pH: Normal 4-4.5

-  Swab MCS

-  Saline Microscopy: Hyphae

 

Mx

-  No need to Rx male partner

-  Antifungal

-  PV Imidazole for 1 week

-  Clotrimazole 1% cream

-   Consider Hydrozole (Clotrimazole + Hydrosortisone) if significant inflammation

-  OR PV Polyene for 2 weeks

-  +/- Ketoconazole 200mg PO BD for 5/7

-  OR Fluconazole 150mg PO stat

-  Pregnancy

-  Topical creams (not PO therapy)

-   Clotrimazole 1% cream (externally only, not intravaginally)

 

 

 

References

 

ACT Government CSHC Factsheet: Candida, June 2004