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Candidal Vaginitis

By

Oluwatosin Goje

, MD, MSCR, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Topic Resources

Candidal vaginitis is vaginal infection with Candida species, usually C. albicans.

Risk factors for candidal vaginitis include the following:

Symptoms and Signs of Candidal Vaginitis

Vaginal vulvar pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common, as is a thick, white, cottage cheese–like vaginal discharge that adheres to the vaginal walls. Symptoms and signs increase the week before menses. Erythema, edema, and excoriation are common.

Women with vulvovaginal candidiasis may have no discharge, a scanty white discharge, or the typical cottage cheese–like discharge.

Infection in male sex partners is rare.

Recurrences after treatment are uncommon.

Diagnosis of Candidal Vaginitis

  • Vaginal pH and wet mount

Criteria for diagnosing candidal vaginitis include

  • Typical discharge (a thick, white, cottage cheese–like vaginal discharge)

  • Vaginal pH is < 4.5

  • Budding yeast, pseudohyphae, or mycelia visible on a wet mount, especially with potassium hydroxide (KOH)

If symptoms suggest candidal vaginitis but signs (including vulvar irritation) are absent and microscopy does not detect fungal elements, fungal culture is done. Women with frequent recurrences require culture to confirm the diagnosis and to rule out non-albicans Candida.

Diagnosis reference

  • 1. Schwebke JR, Gaydos CA, Nyirjesy P, et al: Diagnostic performance of a molecular test versus clinician assessment of vaginitis. J Clin Microbiol 56 (6):e00252-18, 2018. doi: 10.1128/JCM.00252-18 Print 2018 Jun.

Treatment of Candidal Vaginitis

  • Antifungal drugs (oral fluconazole in a single dose preferred)

  • Avoidance of excess moisture accumulation

Keeping the vulva clean and wearing loose, absorbent cotton clothing that allows air to circulate can reduce vulvar moisture and fungal growth.

Topical or oral drugs are highly effective for candidal vaginitis (see table Drugs for Candidal Vaginitis Some Drugs for Candidal Vaginitis Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. (See also Overview of Vaginitis.) Most fungal vaginitis is caused by C. albicans (candidiasis), which colonizes... read more Some Drugs for Candidal Vaginitis ). Adherence to treatment is better when a one-dose oral regimen of fluconazole 150 mg is used. Topical butoconazole, clotrimazole, miconazole, and tioconazole are available over the counter. However, patients should be warned that topical creams and ointments containing mineral oil or vegetable oil weaken latex-based condoms.

If symptoms persist or worsen during topical therapy, hypersensitivity to topical antifungals should be considered.

Table
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Frequent recurrences require long-term suppression with oral drugs (fluconazole 150 mg weekly to monthly or ketoconazole 100 mg once a day for 6 months). Suppression is effective only while the drugs are being taken. These drugs may be contraindicated in patients with liver disorders. Patients taking ketoconazole should be monitored periodically with liver function tests.

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