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Candida - female genital - Management
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Definition
- Vulvovaginal candidiasis is a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection, usually a Candida species.
- Vulvovaginal candidiasis during pregnancy is considered to be complicated vulvovaginal candidiasis, because it requires more intensive treatment than uncomplicated vulvovaginal candidiasis.
How should I manage vulvovaginal candidiasis in women who are pregnant?
- Treat with intravaginal clotrimazole or miconazole for at least 7 days.
- Advise the woman that care should be taken when using an applicator during pregnancy to avoid physical damage to the cervix. Some women prefer to insert pessaries by hand when pregnant.
- For vulval symptoms consider using a topical imidazole cream (e.g. clotrimazole), in addition to an intravaginal imidazole.
- Do not use oral antifungals such as fluconazole and itraconazole.
- Advise the woman to return if symptoms have not resolved within 7–14 days.
In depth
How should I manage treatment failure in women who are pregnant?
- Check that treatments have been used as recommended.
- Consider alternative diagnoses.
- Reassess for other predisposing risk factors, and remove or control as far as possible.
- Send a vaginal specimen for culture.
- Manage:
- Give general advice about avoiding local irritants (such as soaps and shower gels) and tight-fitting synthetic clothes.
- If symptoms are improving, consider giving a second course of an intravaginal antifungal (clotrimazole or miconazole).
- Do not use oral antifungals such as fluconazole or ketoconazole.
- For vulval symptoms, consider prescribing a topical imidazole cream (e.g. clotrimazole) in addition to an intravaginal imidazole.
- Refer, or seek specialist advice if:
- Compliance has been a problem because of adverse effects.
- Symptoms are not improving and treatment failure is unexplained.
In depth
When should I treat the sexual partner of a woman with vulvovaginal candidiasis?
- Treat the sexual partner only if they are symptomatic.
In depth
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