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Recurrent vaginal candidiasis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Recurrence of vulvovaginal candidiasis is particularly likely if there are predisposing factors, such as antibacterial therapy, pregnancy, diabetes mellitus, or possibly oral contraceptive use (1)

reservoirs of infection may also lead to recontamination and should be treated; these include other skin sites such as the digits, nail beds, and umbilicus as well as the gastro-intestinal tract and the bladder
the partner may also be the source of re-infection and, if symptomatic, should be treated with a topical imidazole cream at the same time.

Treatment against candida may need to be extended for 6 months in recurrent vulvovaginal candidiasis.

Some alternative recommended regimens include (1):

initially, fluconazole by mouth 150 mg every 72 hours for 3 doses, then 150 mg once every week for 6 months;
initially, intravaginal application of a topical imidazole for 10-14 days, then clotrimazole vaginally 500-mg pessary once every week for 6 months;
initially, intravaginal application of a topical imidazole for 10-14 days, then itraconazole by mouth 50-100 mg daily for 6 months.

Public Health England guidance states:

If recurrent vaginal candidiasis

fluconazole (induction/maintenance)
- 150mg every 72 hours for 3 doses THEN 150mg once a week

A systematic review showed that weekly treatment with fluconazole (150 mg) for six months was effective against recurrent vulvovaginal candidiasis (2).

Patients with recurrent vaginal thrush can be advised on self-help measures. These may include:

if there is any bowel reservoir of organisms then consider treatment with oral antifungals will treat bowel infection
treatment of male sexual partner (treatment is simultaneous)
avoid precipitating factors e.g. tight fitting clothes,
the use of natural yoghurt (taken orally or given intravaginally) - the bacteria in the yoghurt apparently produce pH changes in the vagina that discourage the growth of candida
diabetes must be excluded
- a large proportion of vulvovaginal candidiasis in diabetes is due to non-albicans Candida species such as C. glabrata (3)
- observational studies indicate that diabetic patients with C. glabrata vulvovaginal candidiasis respond poorly to azole drugs

Reference:

Candidiasis

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Recurrent vaginal candidiasis

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