Vaginal thrush

Yeasts may be present in a woman's vagina or vulva with no symptoms present.

• common among women of reproductive age
  
  
• caused by overgrowth of yeasts; C. albicans, in 70-90% of cases, with non-albicans species such as C. glabrata in the remainder
  
  
• presence of candida in the vulvovaginal area does not necessarily require treatment, unless symptomatic, as between 10% and 20% of women will have vulvovaginal colonisation
  
  
• candidiasis occurs most commonly when the vagina is exposed to estrogen, therefore it is more common during the reproductive years and during pregnancy
  • an episode of vulvovaginal candidiasis (VVC) is often precipitated by use of antibiotics
  • immunocompromised women and women with diabetes are predisposed to candidiasis
    
    
• VVC does not appear to be associated with tampons, sanitary towels or panty liners when they are used appropriately
  
  
• as VVC can be found in non-sexually active individuals, it is not classed as an STI

Key points (2):

• all topical and oral azoles give over 80% cure
• pregnant: avoid oral azoles, the 7 day courses are more effective than shorter ones
• recurrent (>4 episodes per year): 150mg oral fluconazole every 72 hours for 3 doses induction, followed by 1 dose once a week for 6 months maintenance

Reference:

• 1) FSRH and BASHH Guidance (February 2012) Management of Vaginal Discharge in Non-Genitourinary Medicine Settings.
• 2) Public Health England (June 2021). Managing common infections: guidance for primary care