Vulvovaginal candidiasis (VVC) is generally not sexually acquired or transmitted. Most infections are caused by Candida albicans, a dimorphic fungus that grows as oval budding yeast cells (commonly observed in vaginal secretions) and as pseudohyphae. Approximately 10%–20% of women will have complicated VVC that necessitates diagnostic and therapeutic considerations.
History may include:
Contraceptive method; condom/spermicide use
Recent use of antibiotics, corticosteroids, or chemotherapy
Terconazole0.4% cream 5 g intravaginally for 7 days
Terconazole 0.8% cream 5 g intravaginally for 3 days
Terconazole 80 mg vaginal suppository, one suppository for 3 days
Fluconazole 150 mg oral tablet, one tablet in single dose (Avoid in Pregnancy)
Compromised Host: Women with underlying debilitating medical conditions (e.g., those with uncontrolled diabetes or those receiving corticosteroid treatments) do not respond as well to short-term therapies. Efforts to correct modifiable conditions should be made, and more prolonged (i.e., 7–14 days) conventional antimycotic treatment is necessary.
Pregnancy: VVC frequently occurs during pregnancy. Only topical azole therapies, applied for 7 days, are recommended for use among pregnant women.
HIV Infection: The incidence of VVC in HIV-infected women is unknown. Vaginal Candida colonization rates among HIV-infected women are higher than among those for seronegative women with similar demographic characteristics and high-risk behaviors, and the colonization rates correlate with increasing severity of immunosuppression. Symptomatic VVC is more frequent in seropositive women and similarly correlates with severity of immunodeficiency.
Persistent or chronic Infections: For clients who have persistent infections or chronic infections (3-5/year) should be managed by either referral or assessed for health conditions (i.e., diabetes, immune suppression, HIV).
Creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms.