Treatment of vaginal candidiasis

Principles of treatment:

• application of topical antifungal agents for sufficient time to be effective
• to avoid re-infection from sexual partner - sexual intercourse should be avoided until cure is complete
• prevention of auto-infection from the bowel
• the vulva must be kept cool and dry. This is achieved by careful hygiene, use of cotton rather than synthetic underwear and careful drying after washing vaginal area.

Treatment options (1):

• clotrimazole 500mg pessary stat OR
• fenticonazole 600mg pessary stat OR
• clotrimazole 100mg pessary for 6 nights OR
• oral fluconazole 150mg stat

If recurrent: fluconazole (induction/maintenance) (1)

• 150mg every 72 hours for 3 doses THEN 150mg once a week

Note that oral treatment should not be given to either pregnant women or to nursing mothers (2).

Post-antibiotic candidal vulvovaginitis:

• a study suggested that the use of oral or vaginal forms of lactobacillus did not prevent post-antibiotic candida vulvovaginitis (3)

Reference:

1. Public Health England (June 2021). Managing common infections: guidance for primary care
2. MeReC Bulletin (2004); 14 (4): 13-16.
3. Pirotta M et al. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ 2004;329:548