Vulvovaginal candidiasis (genital thrush): symptomatic inflammation of vagina and/or vulva secondary to fungal infection.

Recurrent infection: ≥4 symptomatic episodes in 1 year, at least 2 confirmed by microscopy / culture (at least one by culture)

Most common genus: Candida yeasts

• Most common species: Candida albicans (80-89% cases)
• Candida glabrata (5%)

• Local irritants - douching, soaps, shampoos, shower gels
• Recent antibiotic use (within 3 months)
• Immunosupression
  • Poorly controlled diabetes mellitus
  • HIV infection
  • Long-term corticosteroid use
• Oestrogen exposure
  • Pregnancy
  • COCP Combined oral contraceptive pill
  • HRTHormone replacement therapy  

Possible symptoms:

• Vulval / vaginal itching (most common), soreness and irritation
• Superficial dyspareunia and dysuria

On examination:

• White 'cheese-like' discharge (non-malodorus)
• Erythema
• Vaginal fissuring and/or oedema
• Excoriations
• Satellite lesions (rare - may indicate other fungal conditions or HSV infection)

Clinical diagnosis is usually sufficient in the presence of typical signs and symtpoms.


Consider the following for recurrent infection / diagnostic uncertainty:

• High vaginal swab of vaginal secretions for microscopy 
  • Self-collected low vulvovaginal swab is also appropriate (if examination of external genitalia not possible or not needed)
  • Culture might be needed for recurrent infection
• Vaginal pH testing of secretions 
  • pH <4.5 supports candidiasis
  • Not needed for diagnosis, but helpful to exclude bacterial vaginosis and trichomoniasis
• Midstream sample of urine 
  • If UTI is suspected

 

• HbA1c - to exclude diabetes mellitus 
• FBC and serum ferritin - to exclude iron deficiency anaemia

NICE CKS Candida - female genital
BASHH Vulvovaginal Candidiasis 2019