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Candida - female genital - Management
How should I manage vulvovaginal candidiasis in women who have poorly controlled diabetes or who are immunocompromised?
- For women who have poorly controlled diabetes or who are are immunocompromised (e.g. receiving immunosuppressant drugs such as long-term corticosteroids, or with HIV/AIDS):
- Correct modifiable conditions (e.g. uncontrolled diabetes).
- Give general advice to avoid local irritants (such as soaps and shower gels) and tight-fitting synthetic clothes.
- Treat with long courses (7 days) of oral antifungals (e.g. fluconazole or itraconazole) or intravaginal antifungals (e.g. clotrimazole, econazole, or miconazole) for 6–14 days.
- Choice of treatment will depend upon a number of factors, including patient preference.
- For vulval symptoms, consider using a topical imidazole cream (e.g. clotrimazole, or econazole), in addition to an oral or intravaginal antifungal.
- For girls aged between 12 and 16 years, offer a 7 day course of an oral antifungal (fluconazole or itraconazole). However, an intravaginal antifungal may be considered if the girl is sexually active, if tampons are being used, or if there is no other alternative.
- Advise the woman to return if:
- Symptoms have not resolved within 7–14 days.
- She becomes systemically unwell.
In depth
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