Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. Symptoms are usually a thick, white vaginal discharge and vulvovaginal pruritus that is often moderate to severe. Diagnosis is with pelvic examination, vaginal pH, and wet mount. Treatment is with oral or topical antifungal medications.
(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
Pregnancy
Constrictive nonporous undergarments
Immunocompromise
Candidal vaginitis is uncommon among women who are postmenopausal, except among those taking systemic menopausal hormone therapy.
Symptoms and Signs of Candidal Vaginitis
Vulvovaginal pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common, as is a thick, white, curd–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 curd-like discharge.
Infection in sex partners is rare.
Recurrences after treatment may occur if there is resistance to antifungals or if a patient has non- Candida albicans species like Candida glabrata.
Diagnosis of Candidal Vaginitis
Pelvic examination
Vaginal pH and microscopy
Culture, if vaginitis is persistent or recurrent
By permission of the publisher. From Sobel JD. In Atlas of Infectious Diseases: Fungal Infections. Edited by GL Mandell and RD Diamond. Philadelphia, Current Medicine, 2000. Also from Sobel JD. In Atlas of Infectious Diseases. Edited by GL Mandell and MF Rein. Philadelphia, Current Medicine, 1996.
Criteria for diagnosing candidal vaginitis include
Typical discharge (a thick, white, curd-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.
Also, some diagnostic tests are commercially available for clinical use (1).
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
Treatment of Candidal Vaginitis
Avoidance of excess moisture accumulation
Keeping the vulva dry and wearing loose, absorbent cotton clothing that allows air to circulate can reduce vulvar moisture and fungal growth.
Topical or oral medications are highly effective for candidal vaginitis (see table Medications for Candidal Vaginitis
If symptoms persist or worsen during topical therapy, hypersensitivity to topical antifungals should be considered.
Treatment reference
1. Sobel JD, Wiesenfeld HC, Martens M, et al: Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 351(9):876-883, 2004. doi:10.1056/NEJMoa033114
