Candida

Question 1

Definition of recurrent VVC

Answer 1

4 episodes in 12/12 with at least 2 on microscopy or culture. One needs to be culture with mod to heavy growth

Question 2

Candida species

Answer 2

Albicans 80-90%
Glabrata
Tropicalis 
Krusei 
Parapsilosis

Question 3

Microscopy features of Candida and those that might be glabrata indicativ

Answer 3

Spores, hyphae, neutrophils

If just neutrophils and spores only - glabrata potentially

Question 4

Rx for acute VVC

Answer 4

Fluconazole 150mg po stat
Or
Clotrimazole pessary 500mg PV stat

Question 5

Alternative acute VVC regimes

Answer 5

Clotrimazole vaginal cream 5g stat
Clotrimazole 200mg ON for 3 nights
Econazole 150mg pessary stat or for 3 nights
Itraconazolr 2000mg BD for 1 day
Miconazole 1200mg stat

Question 6

Considerations for azole therapy for Candida

Answer 6

No oral in pregnancy
Topical can weaken codnoms and diaphragm
Topical can worsen Sx
Some Azores prolonged QT

Question 7

Severe episode of VVC Rx

Answer 7

Lots of erythema oedema fissures
Fluconazole 150mg on D1 and D4
Same with clotrimazole pessary D1 and D4
Miconazole 1200mg on D1 and D4

Question 8

Recurrent VVC Rx

Answer 8

Induction fluconazole 150mg orally every 72 hours for 3 doses
Maintenance fluconazole 150mg once a week for 6/12

Alt
Induction topical imidazole for 7-14 days
Maintenance clotrimazole pessary once a week or itraconazole 100mg oral daily
If relapse in between than twice weekly fluclox/ consider cetirizine

Question 9

Pregnancy Mx of VVC

Answer 9

Clotraimzole pessary 500mg for 7 nights
Clotrimazole vag cream 5G for 7 nights
Miconazole 1200mg vaginalk for 7/7

Recurrent VVC
Induction - topical imidazole for 10-14/7
Maintenance clotrimazole pessary 500mg weekly

Question 10

Rx of non Candida species

Answer 10

Nystatin pessaries 100,000 units every night for 14/7
Alt
Boric acid vaginalky 600mg daily for 14/7

Recurrent VVC due to azole resistance
Nystatin pessary 100,000 14 nights of the month for 6/12