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Candida - female genital - Management
How should I manage treatment failure in uncomplicated vulvovaginal candidiasis?
- Check that treatments have been used as recommended.
- Topical azole therapies can cause vulvovaginal irritation, so consider this if symptoms persist or worsen.
- Consider alternative diagnoses — 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 microscopy and culture.
- Treat:
- If non-compliance has been a problem with an intravaginal imidazole, prescribe a short course of an oral antifungal (e.g. fluconazole or itraconazole).
- If symptoms are improving, consider treating with a longer course of an oral (e.g. itraconazole or fluconazole) or an intravaginal (e.g. clotrimazole, econazole, or miconazole) antifungal.
- For girls aged between 12 and 16 years oral antifungals (itraconazole or fluconazole) 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.
- For vulval symptoms, consider prescribing a topical imidazole (e.g. clotrimazole, or econazole) cream in addition to an oral or intravaginal antifungal.
- Refer, or seek specialist advice, if:
- Symptoms are not improving and treatment failure is unexplained.
- Treatment fails again.
- If diagnosis is unclear.
In depth
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