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: Diagnosis based on history and physical alone are unreliable | If pH paper, KOH, and microscopy are not available, FDA approved commercial tests are available
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.
Recurrence (Candida albicans)
Severe Infection (erosions, fissures, edema)
If NAC confirmed
Note: Oral fluconazole used at high doses for extended periods of time may be associated with a small increase in birth defects | There have been conflicting studies regarding miscarriage and stillbirth | The FDA did not find conclusive evidence for risk of stillbirth or miscarriage with single 150 mg dose (see ‘Related ObG Topics’ below) | The FDA does “advise cautious prescribing of oral fluconazole in pregnancy”
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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