Candidiasis

Question 1

What is candidiasis?

Answer 1

‘thrush’- vaginal infection with a yeast of Candida family. Most common yeast is Candida albicans.

Question 2

What are the risk factors for candidiasis?

Answer 2

Increased oestrogen (higher in pregnancy, lower pre-puberty & post menopausal). Poorly controlled diabetes. Immunosuppression eg. corticosteroids, HIV. Broad spectrum antibiotics.

Question 3

What is the typical presentation of candidiasis?

Answer 3

• Thick, white discharge
• does not typically smell
• ‘cottage cheese’
• Vulval & vaginal itching, irritation or discomfort.

Question 4

What is the presentation in more severe infection?

Answer 4

• Erythema
• fissures
• oedema
• Dyspareunia
• Excoriation

Question 5

What investigations can be done for candidiasis?

Answer 5

• Test vaginal pH using a swab and pH paper can be helpful in differentiating between BV and trichomonas (pH over 4.5) and candidiasis (pH under 4.5).
• Charcoal swab with microscopy can confirm diagnosis.

Question 6

What is the general management for candidiasis?

Answer 6

• Antifungal cream (clotrimazole) inserted into vagina with applicator. - Antifungal pessary clotrimazole 500mg
• Oral antifungal tablets - oral fluconazole 150mg.

Question 7

If there are vulval symptoms, what can you add?

Answer 7

Consider adding topical imidazole in addition to an oral or intravaginal antifungal.

Question 8

What treatment is recommended if pregnant?

Answer 8

Only local treatments eg. cream or pessaries as oral are contraindicated.

Question 9

What is the NICE management for candidiasis?

Answer 9

1. Single dose of IV clotrimazole cream
2. Single dose of clotrimazole pessary at night
3. 3 doses of clotrimazole over 3 nights
4. Single dose of fluconazole.

Question 10

What is Canesten Duo?

Answer 10

Standard over the counter treatment which contains a single fluconazole tablet and clotrimazole cream to use externally.

Question 11

What other treatment is recommended for recurrent infections?

Answer 11

Recurrent infections (more than 4 in a year) should be treated with an induction and maintenance regime over 6 months with oral or antifungal meds.
- Induction = oral fluconazole every 3 days for 3 doses.
- Maintenance = oral fluconazole weekly for 6 months.

Question 12

What do you need to warn women of when giving them antifungal creams and pessaries?

Answer 12

Can damage latex condoms and prevent spermicides from working, so alternative contraception is required for at least 5 days after use.