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Candida - female genital - Management
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Definition
- In severe vulvovaginal candidiasis there is:
- Extensive vulvar erythema
- Oedema
- Excoriation
- Fissure formation
How should I treat severe vulvovaginal candidiasis?
- Send a vaginal specimen for microscopy and culture.
- Treat:
- Treat with either two doses of oral fluconazole (150 mg) 3 days apart, or, if oral treatment is contraindicated, use two clotrimazole pessaries (500 mg) 3 days apart.
- Choice of antifungal will depend upon a number of factors, including the woman's preference.
- For girls aged between 12 and 16 years, an oral antifungal (fluconazole) is generally preferred over intravaginal treatments. However, intravaginal antifungals may be considered if the girl is sexually active, if she uses tampons, or if there is no other alternative.
- For vulval symptoms, consider using a topical antifungal cream (e.g. clotrimazole or econazole) in addition to an oral or intravaginal antifungal.
- Advise the woman to return if symptoms have not resolved within 7–14 days.
In depth
How should I manage treatment failure of severe vulvovaginal candidiasis?
- Consider alternative diagnoses — a wrong diagnosis is a common cause for treatment failure.
- Reassess for predisposing risk factors, and remove or control as far as possible.
- Send a vaginal specimen for culture.
- Manage:
- If non-compliance has been a problem with an intravaginal imidazole, prescribe a course of oral fluconazole 150 mg (2 doses 3 days apart).
- If non-compliance has been a problem with oral fluconazole, prescribe clotrimazole pessaries 500 mg (2 doses 3 days apart).
- For vulval symptoms, consider prescribing a topical imidazole cream in addition to an oral or intravaginal antifungal.
- For girls aged between 12 and 16 years, offer oral fluconazole.
- In this age group oral antifungals are generally preferred over intravaginal treatments. However, intravaginal antifungals may be considered if the girl is sexually active, if she uses tampons, or if there is no other alternative.
- Refer, or seek specialist advice, if:
- Symptoms have not improved and treatment failure is unexplained.
- Treatment fails again.
In depth
What general advice can I give about self-management of the current infection?
- Avoid local irritants (such as soaps and shower gels) and tight-fitting synthetic clothes.
- Probiotics (e.g. live yoghurts) may be used orally or topically. Although there is no evidence that they are effective, there is no evidence of (or concern about) adverse effects.
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
Prescriptions
Clotrimazole/severe candida
Age from 16 years onwards
Clotrimazole 500mg pessary x2 doses
Clotrimazole 500mg pessaries
Insert one pessary into the vagina at night and repeat after 3 days
Supply 2 Pessary.
Oral fluconazole/severe candida
Age from 12 years onwards
Fluconazole 150mg x2 doses
Fluconazole 150mg capsules
Take one capsule, then repeat after 72 hours.
Supply 2 capsule.
External cream (add on treatment)
Age from 12 years onwards
Clotrimazole cream 2% apply 2 to 3 times a day
Clotrimazole 2% cream
Apply to the affected area 2 to 3 times a day for up to 7 days
Supply 20 grams.
Econazole 1% cream apply twice a day
Econazole 1% cream
Apply to the affected area twice a day for up to 7 days.
Supply 30 grams.
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