vulvovaginal candidiasis
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Etiology
- Candida albicans (85%)
- Candida glabrata (10-15%)
- risk factors
* for single episode of candidiasis, continue SGLT2 inhibitor[9]
Clinical manifestations
- large erythematous patches over the labia majora, inguinal folds, perianal skin & inner thigh
- pruritus, burning
- dysuria (occasional)
- dyspareunia (occasional)
- thick white vaginal discharge (vaginitis)
Laboratory
- microscopic examination of 10-20% KOH mount of vaginal discharge
- hyphae, pseudohyphae, yeast or budding spores
- sensitivity of microscopy is low*[2]
- pH of discharge <= 4.5
- Candida DNA in vaginal fluid
* clinical findings insufficient for diagnosis; laboratory confirmation needed[2]
Management
- miconazole (OTC)
- 200 mg suppository (Monistat 3) vaginally QHS for 3 nights or 100 mg suppository vaginally QHS for 7 nights
- 2% cream, 5 grams vaginally for 7 nights
- vaginal cream QHS for 7 nights[2]
- butoconazole 2% 5 grams for 3 nights
- clotrimazole 1%, 5 grams for 7 nights (Gyne-Lotrimin)
- 100 mg tablet for 7 nights or 200 mg tablet for 3 nights
- up to 14 nights (complicated C albicans vulvovaginitis)
- fluconazole 150 mg PO
- single dose (uncomplicated C albicans vulvovaginitis)
- 3 doses 72 hours apart (complicated C albicans vulvovaginitis)[2]
- non C albicans vulvovaginal candidiasis
- initial treatment with 7-14 days of oral or topical with non imidazole antifungal agent such as voriconazole
- frequently recurrent
- fluconazole 150 mg PO weekly for recurrent vulvovaginal candidiasis[4]
- boric acid vaginal suppository for azole-resistant vulvovaginal candidiasis
- daily for 2 weeks, then twice a week for 6 months[7]
- lactobacillus not helpful[6]
- mitigation of risk factors
- for single episode of candidiasis, continue SGLT2 inhibitor[9]
* empiric therapy indicated if symptoms accompanied by characteristic findings
More general terms
- vulvar dystrophy (vulvar disorder)
- mucocutaneous candidiasis (includes vulvovaginal candidiasis)
- vulvovaginitis
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 436-37
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
- ↑ Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ 4.0 4.1 Journal Watch 24(18):141, 2004 Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, Sperling M, Livengood C 3rd, Horowitz B, Von Thron J, Edwards L, Panzer H, Chu TC. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004 Aug 26;351(9):876-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15329425
- ↑ Prescriber's Letter 11(11):64 2004 Fluconazole (Diflucan) Prophylaxis for the Treatment of Recurrent Vulvovaginal Candidiasis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201104&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 Journal Watch 24(21):162, 2004 Pirotta M, Gunn J, Chondros P, Grover S, O'Malley P, Hurley S, Garland S. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ. 2004 Sep 4;329(7465):548. Epub 2004 Aug 27. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15333452 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7465/548
- ↑ 7.0 7.1 Prescriber's Letter 17(8): 2010 CHART: Treatment of Complicated Vaginal Yeast Infections CHART: Treatment of Uncomplicated Vaginal Yeast Infections GUIDELINES: Infectious Diseases Society of America Guidelines for the Management of Candidiasis (2009 update) GUIDELINES: Sexually Transmitted Diseases Treatment Guidelines (2006) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260806&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010 Apr;23(2):253-73. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20375352 Free PMC Article
- ↑ 9.0 9.1 9.2 NEJM Knowledge+