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Candidiasis (Risk factors (DM, Immunocompromised HIV, immunosuppressive…
Candidiasis
Risk factors
DM
Immunocompromised
HIV, immunosuppressive drugs
Oestrogen exposure
Reproductive years
?COCP, HRT
Pregnancy
Abx treatment
Broad-spec
Local irritants
Soaps, shower gels, tight clothes
Sexual behaviours
Especially oral
Contraception
Spermicide, ?COCP
Epidemiology
20% women colonised asymptomatically
Second commonest cause of vaginitis (after BV)
75% affected during lifetime, <5% recurrent
Pathophysiology
Mechanism
In women, a change in vaginal pH or sex hormones can
allow candida proliferation and symptomatic disease
Classification
Uncomplicated: sporadic/infrequent, mild-mod severity, caused by candida albicans, no risk factors
Complicated: recurrent infection (4+/y), severe infection, yeasts other than candida albicans, risk factors present
Agent
Commonly Candida albicans, occasionally other yeasts
Diagnosis
(clinical)
Examination
External genital examination
Female: erythematous, swollen vulvae,
excoriations, fissures, satellite lesions, discharge
Investigations
Swabs
Vaginal pH test (if unsure candida [pH<5] vs BV/TV [pH>5])
HVS (MCS for candida)
STI screen (ECS/VVS for NG/CT NAAT)
Urine
MSU (to exclude UTI)
Bloods
STI screen (HIV, syphilis, HBV/HCV)
History
Reproductive history
Gynae: menses, bleeding, contraception, smears
SxH
Partners (regular/casual, gender, age)
Type of sex (vaginal/ora/anal, receptive/passive)
Contraception (barrier or UPSI)
Partners (last 3m, last 12m)
BBV risk (overseas, IVDU, paid for sex, blood transfusions)
PMH
Previous episodes, STIs
SH
Occupation, living arrangements,
smoking, alcohol, drugs
PC/HPC
Itching, soreness, discharge, pain, dysuria,
previous episodes, treatments, recent abx,
exclude red flags (bleeding, weight loss, fevers)
Complications
Psychosocial
Depression, anxiety, psychosexual issues
Treatment failure
10-20% women
Candidal balanitis
Male partners of affected women
Clinical
presentation
Women
Vulval itching
Vulval soreness/irritation
Discharge (white, thick, non-odorous)
Dysuria
Superficial dyspareunia
Men
Penile itching (balanitis)
Management
Conservative
Information and advice
Advise return if not resolved 7-14d
Self care: avoid irritant washing products (use soap substitute), avoid douching, avoid washing vulva >1/d, avoid tight fitting clothes, use simple emollient, consider oral/topical probiotics)
Referral if unclear diagnosis, treatment failure, young pt (<15y)
If male candidiasis, investigate and tx female partner
Medical
Pessary antifungal
Indication: 1L uncomplicated candidiasis
E.g. clotrimazole pessary
Oral antifungal
Indication: uncomplicated (pt preference);
1L severe infection/recurrent infection
E.g. fluconazole, itraconazole PO;
weekly tx for 4-66m in recurrent infection
CI: pregnancy
Topical antifungal
Indication: vaginal symptoms, in addition to pessary/PO tx
E.g. clotrimazole cream, ketoconazole cream
Prognosis
Uncomplicated candidiasis resolves
with treatment in ~90% women
Recurrent candidiasis affects 5% women
Definition
Infection of the genitals by a fungus,
causing inflammation and itch