Vulvovaginal candidiasis (VVC) presents with symptoms of itching, redness and discharge. Recurrent VVC (RVVC) is diagnosed when women have ≥4 episodes of VVC within 12 months.
Note: Sensitivity of microscopy is only 50% to 70% and many cases will go undetected | False negative work-up more likely if patient has self-treated with OTC medications | Newer FDA approved commercial tests have higher sensitivities and “may prove to be useful”
Classify as uncomplicated or complicated
VVC is a common clinical condition with most infections due to C. albicans. Uncomplicated infections respond promptly to 1-,3- and 7- day treatment options (see below). Complicated/recurrent VVC may require longer duration of treatment and higher doses of medication. NAC subtypes may be resistant to typical treatment.
Uncomplicated
Complicated
Recurrence (Candida albicans)
Severe Infection (erosions, fissures, edema)
If NAC confirmed
Pregnancy
Note: The CDC states “Epidemiologic studies indicate a single 150-mg dose of fluconazole might be associated with spontaneous abortion and congenital anomalies; therefore, it should not be used”
Other treatments
ACOG Practice Bulletin 215: Vaginitis in Nonpregnant Patients
An Update on the Roles of Non-albicans Candida Species in Vulvovaginitis
BMJ Clinical Evidence: Candidiasis (vulvovaginal)
CDC STI Treatment Guidelines 2021: Vulvovaginal Candidiasis
BMJ: Recurrent vulvovaginal candidiasis
Oral Fluconazole in Pregnancy and Risk of Stillbirth and Neonatal Death
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