Candidiasis

Question 1

Candidiasis is infection with ______ caused by _________

Answer 1

Infection with Candida species, caused by an overgrowth of the organisms often present in small amounts in the genital tract

Question 2

What is the usual organism that causes candidiasis?

Answer 2

Candida albicans

Question 3

Is candidiasis considered to be an STI?

Answer 3

No

Question 4

What causes candidiasis?

Answer 4

Often no clear cause but some risk factors have been identified

Question 5

Risk factors for candidiasis include…

Answer 5

Abx use (within past 3m)
Poorly controlled diabetes
Increase in oestrogen (exogenous or endogenous) including pregnancy, MHT and possibly COC
Skin conditions e.g. eczema or dermatitis
Immunosuppression

Question 6

Candidiasis may cause _________ in males, especially if __________

Answer 6

May cause balanitis, especially if uncircumcised

Question 7

Presentation of vulvovaginal candidiasis infection

Answer 7

White ‘curd like’ vaginal discharge
Genital or vulval itch, discomfort
Superficial dyspareunia
External dysuria
Excoriation, erythema, fissures, swelling

Question 8

Is discharge always abnormal with candidiasis?

Answer 8

No, can appear normal

Question 9

Presentation of penile candidiasis infection

Answer 9

Red rash on genitals, especially under foreskin (may or may not be itchy)
Swelling of foreskin if severe
Fissures
Superficial erosions

Question 10

How common is candidiasis in women?

Answer 10

~75% women will experience at least one lifetime episode

Question 11

_____ % of women will have recurrent candidiasis

Answer 11

<5%

Question 12

Recurrent candidiasis defined as…

Answer 12

4 or more symptomatic episodes within 12 months

Question 13

Indications for testing for candidiasis

Answer 13

Vaginal discharge
Vaginal odour or itch
Genital discomfort
Superficial dyspareunia
Genital rash, erosions or fissures

Question 14

Should you test asymptomatic people for candidiasis?

Answer 14

Routine screening in asymptomatic people is not recommended

Question 15

Why is examination recommended for candidiasis?

Answer 15

Exam is recommended for thorough assessment as symptoms are non-specific and may be due to other conditions such as dermatitis or genital herpes

Question 16

What can you do if examination is declined?

Answer 16

Self-collected swabs can be done if exam is declined, but this is not recommended

Question 17

Should you also check for STIs?

Answer 17

STIs symptoms are similar to those of candidiasis. Unless STIs have been excluded, testing should occur as part of a full sexual health check

Question 18

Recurrent candidiasis should be confirmed by ___________ before considering suppressive therapy

Answer 18

Culture or microscopy on at least 2 occasions

Question 19

Recommended test for vulvovaginal candidiasis

Answer 19

High vaginal swab for Candida and BV

Question 20

________ is another common cause of unusual vaginal discharge

Answer 20

BV

Question 21

Other tests to consider

Answer 21

Vulvovaginal NAAT swab for chlamydia, gonorrhoea and trichomoniasis
HIV and syphilis serology if STI testing indicated

Question 22

Recommended tests for penile infection

Answer 22

Usually diagnosed based on signs and symptoms but can do culture swab for yeast

Question 23

People with confirmed recurrent candida balanitis should be screened for ________

Answer 23

Diabetes

Question 24

People with recurrent candida balanitis should discuss…

Answer 24

Status of their sexual partner(s) should be discussed (often occurs in the context of untreated recurrent vulvovaginal candidiasis in the partner)

Question 25

Should you treat asymptomatic people?

Answer 25

No Only treat symptomatic people

Question 26

What's more effective - oral or topical treatments?

Answer 26

Topical and oral azoles have a similar efficacy

Question 27

Although not specifically recognised as risk factors people with recurrent candidiasis may benefit from avoidance of...

Answer 27

Perfumed products and tight clothing that promotes excessive sweating e.g. wetsuits, synthetic underwear

Question 28

If breakthrough symptoms on suppressive therapy occur...

Answer 28

Confirm ongoing candida before changing treatment regimen. Request culture swab for speciation and sensitivities, and write ‘breakthrough symptoms while on suppressive therapy’ on the request form

Question 29

Recommended treatment for acute vulvovaginal candidiasis

Answer 29

Clotrimazole 2% vaginal cream, one vaginal applicator every night for 3 days OR Fluconazole 150 mg orally, as a single dose

Question 30

Alternative treatment for acute vulvovaginal candidiasis

Answer 30

Nystatin vaginal cream, one applicator 1-2 times daily for 2 weeks OR Miconazole 2% vaginal cream, one vaginal applicator every night for 7 days

Question 31

Recommended treatment for acute penile candidiasis

Answer 31

Clotrimazole 1% topical cream twice daily for 5-7 days

Question 32

Alternative treatment for acute penile candidiasis

Answer 32

Miconazole 2% topical cream twice daily for 5-7 days

Question 33

Recommended treatment for recurrent vulvovaginal candidiasis

Answer 33

Induction with fluconazole 150 mg orally, every 72 hours for 3 doses, followed by maintenance with fluconazole 150 mg orally, weekly for 6 months

Question 34

Alternative treatment for recurrent vulvovaginal candidiasis

Answer 34

Clotrimazole 2% vaginal cream one vaginal applicator every night for 3 days. Repeat every month for 6 months

Question 35

What should you do if recurrent vulvovaginal candidiasis due to non-albicans species or resistant C. albicans

Answer 35

Seek specialist advice

Question 36

General advice for management/vulval care

Answer 36

Avoid local irritants e.g. soaps, bath oils, body washes, bubble baths, spermicides, vaginal lubricants, vaginal hygiene products Soap substitute for washing e.g. Sorbolene, Cetaphil, QV

Question 37

Important advice in terms of contraception while on treatment for candidiasis

Answer 37

Latex condoms, diaphragms and cervical caps can be damaged by antifungal vaginal creams

Question 38

Should you treat sexual partners?

Answer 38

Sexual partners only require treatment if symptomatic

Question 39

Does diet/probiotics have an effect on candidiasis?

Answer 39

No strong evidence that specific diets or the use of probiotics influence the recurrence of candidiasis

Question 40

Treatment in someone who is breastfeeding

Answer 40

Same as above

Question 41

Treatment in someone who is pregnant

Answer 41

Fluconazole contraindicated, may need longer course of topical treatment

Question 42

Is contact tracing required?

Answer 42

No

Question 43

Is follow up required?

Answer 43

No (unless sx persist or recur) No test of cure required

Question 44

Referral to or discussion with a sexual health specialist is recommended for...

Answer 44

Persistent or recurrent candidiasis Failure to respond to above treatment Complicated clinical situations for further management