Candida vulvovaginitis

Background

• Not considered an STI although it can be transmitted by sexual intercourse
• May occur in premarnarcheal girls (rare)
• Types
  • Uncomplicated
    • Sporadic infxn, mild-moderate sx, due to Candida albicans, immunocompetent
  • Complicated
    • Recurrent infxn, severe sx, uncontrolled DM, immunosuppression, pregnant

Differential Diagnosis

Vulvovaginitis

• Bacterial vaginosis
• Candida vaginitis
• Trichomonas vaginalis
• Contact vulvovaginitis
  • Bubble baths and soaps
  • Deodorants, powders, and douches
  • Clothing
• Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
• Lichen sclerosus
• Tinea cruris
• Chlamydia/Gonorrhea infection
• Pinworms
• Vaginal foreign body
  • Toilet paper
  • Other
• Genitourinary syndrome of menopause
• Foreign body
• Allergic reaction
• Normal physiologic discharge

Diagnosis

• Vaginal pruritus is the most common and specific symptom
• Dischrage varies from little to copious and from watery to cottage-cheese like
• Odor is unusual (if present favors dx of BV)
• Wet mount shows hyphae and yeast buds
  • Candida does not cause WBCs on wet mount, think about co-infection with other vaginitides or STI

Treatment

• Do not treat if asymptomatic
• Sexual partners should not be treated unless the pt has frequent recurrences
• Single-dose tx w/ oral flucon is as effective as topical tx but can't use in pregnancy
• Uncomplicated
  • Clotrimazole 100mg vaginal tablet; 2 tablets/d x3d OR
  • Fluconazole 150mg PO x1dose
• Complicated
  • Fluconazole 150mg PO on days 1 and 3 (not recommended for pregnant pts)
  • Topical azole therapy x7d (for pregnant pts)

See Also

• Vulvovaginitis
• Fungal Infections

Source

Tintinalli