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Candida - female genital - Management
What risk factors for vulvovaginal candidiasis should I consider?

  • Enquire into the presence of risk factors for vulvovaginal candidiasis, such as recent use of antibiotics, pregnancy, diabetes mellitus, and immunocompromised status.
  • Consider testing for risk factors.
Clarification / Additional information
  • Diabetes mellitus:
    • Screen the urine for glucose in women with recurrent or complicated vulvovaginal candidiasis.
    • Consider a fasting glucose test for postmenopausal women and for women with symptoms suggestive of diabetes mellitus. For more information see the CKS topic on Diabetes type 2.
  • HIV:
    • Do not test for HIV in women with vulvovaginal candidiasis (uncomplicated, complicated, or recurrent) unless there are other features suggestive of immunosuppression and high risk for HIV.
  • Hormonal contraceptives:
    • Do not advise stopping hormonal contraceptives, even in women with severe or recurrent vulvovaginal candidiasis.
Basis for recommendation
  • The evidence on risk factors is summarized in the section Risk factors.
  • These recommendations are mainly based on expert opinion because CKS found no relevant clinical trials.
  • Diabetes mellitus:
    • Two guidelines recommend excluding diabetes mellitus in women with recurrent vulvovaginal candidiasis [BASHH, 2002; FFPRHC and BASHH, 2006].
    • An American expert has recommended doing a glucose-tolerance test for postmenopausal women because they rarely have vulvovaginal candidiasis without an underlying risk factor. The risk (prior probability) of diabetes in this group was not estimated [Sobel, 2003; Sobel, 2007].
    • CKS therefore recommends testing the urine for glucose in women with severe or recurrent vulvovaginal candidiasis, and considering a glucose-tolerance test for postmenopausal women with vulvovaginal candidiasis.
  • HIV:
    • One expert recommends that only women with recurrent vulvovaginal candidosis who have risk factors for HIV infection should be tested for HIV [Sobel, 2007]. The reasoning is that:
      • Up to 8% of women who are HIV negative have recurrent vulvovaginal candidosis.
      • Most women who have vulvovaginal candidosis are HIV negative.
      • The benefits of screening women in this group for HIV are doubtful and have not been studied.
    • One study of women with HIV/AIDS found that oral candidiasis was more frequent than vulvovaginal candidiasis [Ohmit et al, 2003].
    • Vulvovaginal candidiasis is no more severe in women with HIV than those without [Duerr et al, 2003].
    • CKS therefore recommends that otherwise healthy women should not be tested for HIV.
  • Hormonal contraceptives:
    • One expert states that there is no good evidence that hormonal contraceptives increase the risk of vulvovaginal candidiasis, and thus there is no reason to stop them, even in women with recurrent vulvovaginal candidiasis [Sobel, 2003; Sobel, 2007].

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