Candidiasis (Thrush)

Question 1

What causes vaginal candidiasis?

Answer 1

• it is a vaginal infection with a yeast of the Candida family
• the most common is Candida albicans

Question 2

When does candida tend to cause symptoms?

Answer 2

• it can colonise the vagina without causing symptoms
• it progresses to infection when the optimum environment occurs
  • e.g. during pregnancy
  • or after treatment with broad spectrum abx that alter the vaginal flora

Question 3

What are the risk factors for candida infection?

Answer 3

• high oestrogen (e.g. during pregnancy)
• poorly controlled diabetes
• immunosuppression (+ use of corticosteroids)
• broad-spectrum antibiotics

Question 4

What are the symptoms of candidiasis?

Answer 4

• thick, white discharge that does not smell
• vulval / vaginal itching, irritation or discomfort

Question 5

What can more severe candidiasis result in?

Answer 5

• dyspareunia
• erythema
• fissures
• excoriation
• dysuria
• oedema

Question 6

When is treatment started for candidiasis?

Answer 6

usually treatment is started empirically based on presentation

Question 7

What investigations may be performed?

Answer 7

vaginal pH:

• in candidiasis, the pH will be < 4.5
• in BV or trichomoniasis, the pH will be > 4.5

charcoal swab + microscopy:

• confirms the diagnosis

Question 8

What is the treatment for candidiasis?

Answer 8

treatment involves anti-fungal medications that can be delivered in several ways:

• anti fungal cream (e.g. clotrimazole) inserted into the vagina with an applicator
• anti fungal pessaries (e.g. clotrimazole)
• oral anti fungal tablets (e.g. fluconazole)

Question 9

What is the treatment recommendation if antifungal cream is being used?

Answer 9

a single dose of intravaginal clotrimazole cream at night

(5g of 10% cream)

Question 10

What is the treatment recommendation if antifungal pessaries are being used?

Answer 10

• a single dose of clotrimazole pessary (500mg) at night

OR

• 3 doses of clotrimazole pessaries (200mg) over 3 nights

Question 11

What is the treatment recommendation if oral antifungal medication is used?

Answer 11

a single dose of fluconazole 150mg

Question 12

What is Canesten Duo?

Answer 12

• an over the counter medication
• it contains a single fluconazole tablet** and **clotrimazole cream to use externally for vulval symptoms

Question 13

What advice needs to be given to women before prescribing antifungal creams or pessaries?

Answer 13

• they can damage latex condoms and prevent spermicides from working
• alternative contraception is required for at least 5 days after use