Sexually Transmitted Diseases - Candidiasis

Question 1

What is Thrush? (2)

Answer 1

1. Vaginal Candidiasis - infection with commonest : Candida albicans.
2. Can colonise without symptoms - then, infection when right environment occurs e.g. pregnancy or after treatment with broad-spectrum antibiotics that alter vaginal flora.

Question 2

Risk Factors of Thrush (4).

Answer 2

1. Increased Oestrogen Exposure (Pregnancy - not pre-puberty or post-menopause).
2. Poorly Controlled Diabetes.
3. Immunosuppression (Steroids).
4. Broad-Spectrum Antibiotics.

Question 3

Clinical Presentation of Vaginal Candidiasis (3).

Answer 3

1. Thick white odourless discharge.
2. Vulval/Vaginal Itching, Irritation or Discomfort.
3. Severe : Erythema, Fissures, Oedema, Dyspareunia, Dysuria, Excoriation.

Question 4

Investigations of Vaginal Candidiasis (3).

Answer 4

1. Treat Empirically first.
2. Vaginal pH (pH < 4.5 unlike BV or Trichomonas).
3. Diagnosis : Charcoal Swab with Microscopy.

Question 5

Management of Vaginal Candidiasis (6).

Answer 5

1. Single Dose of Antifungal Cream e.g. Clotrimazole into Vagina with Applicator at Night.
2. Single Dose of Antifungal Pessary e.g. Clotrimazole at Night or 3 Doses (200mg over Nights).
3. Single Dose of Oral Antifungal Tablet e.g. Fluconoazole.
4. OTC : Canesten Duo (Single Fluconazole Tablet and Clotrimazole Cream).
5. Recurrent (4+ annually) : Induction and Maintenance Regime over 6 months : Oral/Vaginal Antifungal Medications.
6. Use alternative contraceptive since anti fungal creams/pessaries damage latex condoms and prevent spermicides.