💡 Treatment options are provided below, but in recurrent or complicated cases, a prompt referral to GUM (Genitourinary Medicine) for further investigation and management is often recommended.
🔬 About
- 🦠 Vaginal Candidiasis is a common fungal infection caused by Candida albicans, though other species (e.g. Candida glabrata) may also be involved.
- ⚠️ Characterised by vaginal itching, soreness, and abnormal discharge.
- 📊 All topical and oral azole treatments show similar efficacy (~75% cure in uncomplicated cases).
⚡ Risk Factors
- 🤰 Pregnancy: Hormonal changes increase susceptibility.
- 💊 Oral contraceptive pill: Higher estrogen → yeast growth.
- 🍭 Diabetes: Poor glycaemic control → recurrent infections.
- 🛡️ Immunosuppression: HIV, steroids, chemotherapy → severe disease risk.
- 💊 Antibiotics: Disruption of vaginal flora → Candida overgrowth.
🩺 Clinical Features
- 🔥 Vaginal itching or soreness: often severe & persistent.
- ❤️🩹 Dyspareunia: Painful intercourse.
- 🚽 Dysuria: Burning with urination.
- 🥛 Abnormal discharge: Thick, white, “cottage cheese-like”.
- 🔴 Severe cases: redness, swelling, fissures → complicated VVC.
🔎 Investigations
- 🔬 Vaginal swab: Microscopy/culture for Candida (esp. in recurrent cases).
- 🍬 Diabetes screen: Fasting glucose or urine dipstick.
- 🧬 HIV testing if recurrent or immunosuppression suspected.
💊 Management
- First-line (uncomplicated):
- 🌙 Clotrimazole 10% vaginal cream: 5g single intravaginal dose.
- 💊 Fluconazole 150 mg: Single oral dose (❌ not in pregnancy).
- Recurrent/severe (≥4 episodes/year):
- 📅 Induction: Fluconazole 150 mg every 72h × 3 doses → Maintenance: weekly for 6 months.
- 🏥 Refer to GUM if persistent.
🤰 Management in Pregnancy
- ❌ Oral fluconazole contraindicated (teratogenicity risk).
- 🌙 Clotrimazole 100 mg pessary nightly × 6 nights.
- 🧴 Miconazole 2% cream: 5g intravaginally BD × 7 days.
- ✅ Local therapy preferred over systemic in pregnancy.
📌 General Advice
- 🧼 Maintain good genital hygiene (cotton underwear, avoid tight clothing, keep dry).
- 🚫 Avoid scented products & douching → disrupts flora.
- 🦠 Probiotics may help restore healthy vaginal flora.
📚 References
