• Uncomplicated vulvovaginal candidiasis is a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection, usually a Candida species. Such infections are:
• Sporadic or infrequent, and
• Mild-to-moderate, and
• Likely to be due to Candida albicans, and
• In women who are not pregnant, diabetic, immunocompromised, or debilitated.

• Prescribe (or recommend over-the-counter purchase of) a short course (1–3 days) of an intravaginal antifungal (e.g. clotrimazole, econazole, or miconazole) or oral antifungal (e.g. fluconazole or itraconazole).
• Choice of route and formulation depends upon a number of factors, including the woman's preference.
• 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 using a topical imidazole cream (e.g. clotrimazole, or econazole) in addition to the oral or intravaginal antifungal.
• Advise the woman to return if symptoms have not resolved within 7–14 days.

In depth

• 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

• 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

• Treat the sexual partner only if they are symptomatic.

In depth