Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) refers to vaginal and vulvalsymptoms caused by overgrowth of a yeast, most often Candida albicans. About 20% of non-pregnant women aged 15–55 harbour C. albicans in the vagina without any symptoms and 75% of women will experience at least one episode of VVC over a lifetime.

VVC is an oestrogen dependent condition and is most commonly observed in women in the reproductive age group. It is quite uncommon in prepubertal and postmenopausal females.

VVC may be triggered by

• Hormonal fluctuations during the menstrual cycle

• Pregnancy

• Higher dose combined oral contraceptive pill

• Oestrogen-based hormone replacement therapy after the menopause, including vaginal oestrogen cream

• A course of broad-spectrum antibiotics such as tetracycline or amoxicillin

• Diabetes mellitus

• Obesity

• Iron deficiency anaemia

• Immunodeficiency such as HIV infection

• An underlying genital skin condition, such as vulval psoriasis, lichen planus or lichen sclerosus

Vulvovaginal candidiasis is characterised by:

• White curd-like vaginal discharge

• Itching, soreness and burning discomfort in the vagina and vulva

• Stinging when passing urine (dysuria)

• Vulval oedema, fissures and excoriations

• Bright red rash affecting inner and outer parts of the vulva, sometimes spreading widely in the groin to include pubic areas, groin and thighs.

Symptoms may be aggravated by sexual intercourse.

Recurrent VVC is usually defined as four or more episodes within one year and may lead to thickened, intensely itchygenital skin (Lichen Simplex).

VVC is diagnosed by clinical examination and confirmed by testing the pH of the vagina and taking a vaginal swab with/without a swab for culture and the laboratory can perform sensitivity testing using disc diffusion methods to guide treatment. Sensitivity to fluconazole predicts sensitivity to other oral and topical azoles.

Topical antifungal pessaries, vaginal tablets or cream containing clotrimazole or miconazole clear symptoms in up to 90% of women with mild symptoms.Newer formulations include butoconazole and terconazole creams.

Oral antifungal medicines containing fluconazole or less frequently, itraconazole, may be used if C albicans infection is severe or recurrent.

Vulvovaginal candidiasis often occurs during pregnancy and can be treated with topical azoles. Oral azoles are best avoided in pregnancy.

Recurrent VVC (RVVC)

RVVC occurs in 5–10% of women in good health. In some women, RVVC may be a sign of iron deficiency, diabetes mellitus or an immune problem and subspecies and sensitivity of the yeast should be determined in treatment-resistance cases

General recommendations include

• Loose-fitting clothing

• Showering rather than bathing

• Vulval skin care with an emollient

• Intermittent hydrocortisone cream for itching

• Oral antifungal medication (usually fluconazole) which is taken regularly 150–200 mg once a week for six months.The dose and frequency depend on the severity of symptoms. Relapse occurs in 50% of women with recurrent vulvovaginal candidiasis when they are discontinued, in which case re-treatment or longer term therapy is required

• Boric acid (boron) 600 mg as a vaginal suppository at night for two weeks reduces the presence of albicans and non-albicans candida in 70% of treated women. Twice-weekly use may prevent recurrent yeast infections.

The following measures have not been shown to help.

• Treating the male does not reduce the number of episodes of candidiasis in their female partner.

• Special low-sugar, low-yeast or high-yoghurt diets are of no benefit

• Probiotics (oral or intravaginal lactobacillus species) may be beneficial

Vulvovaginal Candidiasis

Contact Us