Candidal Vulvovaginitis

• Asymptomatic colonisation with Candida species, occurs in 10–20% of women of reproductive age (30–40% of pregnant women), and does not need treatment.
• If symptomatic, mycological confirmation is recommended because 50% of vulval irritation is caused by other conditions such as vulval dermatoses and allergies.
• Male partners do not usually need treatment. Topical antifungals can be used if symptomatic.
• Treatment may be needed after prolonged antimicrobial courses.
• For recurrent infection (> 4 episodes per year), treat each episode as below and consult Sexual Health/Infectious Diseases/Clinical Microbiology/Obstetrics and Gynaecology – a longer treatment course and/or ongoing maintenance treatment may be indicated.

Pathogens

• Common: Candida albicans
• Other: Non-albicans Candida species

Drug Treatment

• Duration: See below.

Empiric

• If immunocompromised, severe symptoms, or pregnant, consider a long course (e.g., 6 nights of the 2% cream).

OR, if topical treatment is not tolerated or oral therapy preferred:

fluconazole HMLSchedNZFPMLnoids Fluconazole F: 0.9 Half life: 30 hours Elimination: renal fe: 0.8 Additional points: Inhibits CYP3A, 2C8/9, 2C19.

PO 150 mg stat

• No more effective than topical azole treatment (80–90% curative).
• If unresponsive to stat dose consult Sexual Health/Infectious Diseases/Clinical Microbiology/Obstetrics and Gynaecology.
• Avoid in pregnancy.
• fe = 0.8, stat dose – no need to adjust the dose in renal impairment.
• Inhibits CYP3A, 2C8/9 and 2C19.

Non-albicans species, consult Sexual Health/Infectious Diseases/Clinical Microbiology/Obstetrics and Gynaecology and give

Topic Code: 99240

must be prescribed or recommended by a consultant.