Vaginal candidiasis ('thrush') is an extremely common condition which many women diagnose and treat themselves. Around 80% of cases of Candida albicans, with the remaining 20% being caused by other candida species.

The majority of women will have no predisposing factors. However, certain factors may make vaginal candidiasis more likely to develop:

• diabetes mellitus
• drugs: antibiotics, steroids
• pregnancy
• immunosuppression: HIV

Features

• 'cottage cheese', non-offensive discharge
• vulvitis: superficial dyspareunia, dysuria
• itch
• vulval erythema, fissuring, satellite lesions may be seen

Investigations

• a high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis

Management

• options include local or oral treatment
• medication:
  • oral fluconazole 150 mg as a single dose first-line
  • clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
  • If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
• if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

Recurrent vaginal candidiasis

• BASHH define recurrent vaginal candidiasis as 4 or more episodes per year