Vulvovaginal candidiasis

Candidavulvovaginitis, vaginal mycosis, vulvovaginitis candidamycetica, candidacolpitis, candidosis of the vulva, vaginal thrush, soorkolpitis.

Candida infection of the vulva and vagina.

• Lifetime prevalence: 75% of all women

• Predisposing factors:
  • Gravity
  • Pre-existing STI
  • Adnexitis
  • Urethra inflammation
  • Extrauterine pregnancy
  • Sterility problems
  • ↑ sexual activity with different partners (especially without using a condom)
  • Irritation (vaginal douching)
  • diabetes mellitus
  • Taking oral contraceptives
  • Glucocorticoid therapy
  • Antifungal therapy
  • Frequent consumption of sweet foods
  • Stool candidiasis

Transmission can occur via the GI tract as well as via sexual intercourse (partner with Candida infection or sperm colonised with Candida). Transmission is also possible through asymptomatic partners.

Erythematous, pruritic-burning, sometimes confluent papules in the area of the vulva, gloomy whitish discharge, sometimes whitish coatings are visible. Colpitis up to necrotising colpitis

• Clinical
• Native preparation: The slide is smeared with vaginal secretion. After 1 pot of NaCl solution has been applied, pathogens can be found microscopically
• Detection of pathogens: myco. smear (native and culture)
• Germ tube test

• Hygiene:
  • Washing cloths should not be used due to a risk of contamination
  • Underpants and towels should be changed daily and washed at >60°C
  • No use of tampons!
• Ev. use of Lactobacillus acidophilus

• Frequent recurrences
• Stool cultures during the course are important!

• Well treatable with local therapy only
• Partner treatment (also for asymptomatic partners)
• If there is a predisposing underlying disease, this should be addressed therapeutically
• Vaginal tablets
  • Clotrimazole 1 tbl. for 3 consecutive days
  • Econazole 2 tbl. at 12 hour intervals
  • Ciclopirox 1 tbl. on 3 consecutive days
• Topical therapy
  • Clotrimazole cream
  • Econazole cream (1%)
  • Ciclopirox cream
• Systhemotherapy
  • For recurrent candidiasis:
    • Itraconazole p.o. 200 mg 1x tgl. once
    • Alternatively: fluconazole p.o. 150 mg once
    • Alternatively: Terbinafine p.o. 250 mg 1x tgl.

• In case of resistant C. glabrata or C. krusei infection:
  • Voriconazole p.o. Initial dose: 200 mg 2x tgl. for 3 days
  • Posaconazole p.o. 400 mg 2x tgl. for 10 days

• If necessary, treat intestinal mycosis at the same time!

1. Odds FC. Candida infections: an overview. Crit Rev Microbiol 1987;15:1-5.
2. Williams D, Lewis M. Pathogenesis and treatment of oral candidosis. J Oral Microbiol 2011;3.
3. Scully C, el-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med 1994;5:125-57.