(See also Overview of Vaginitis.)
Most fungal vaginitis is caused by C. albicans (candidiasis), which colonizes 15 to 20% of nonpregnant and 20 to 40% of pregnant women.
Risk factors for candidal vaginitis include the following:
Use of a broad-spectrum antibiotic or corticosteroids
Constrictive nonporous undergarments
Use of an intrauterine device
Candidal vaginitis is uncommon among postmenopausal women except among those taking systemic hormone therapy.
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.
Criteria for diagnosing candidal vaginitis include
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.
Also, some relatively new diagnostic tests are commercially available for clinical use (1).
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.
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). 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.
Some Drugs for Candidal Vaginitis
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.