Introduction: Vulvovaginal candidiasis (vvc) is generally not sexually acquired or transmitted. Most infections are caused by Candida albicans



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Candidiasis



  1. INTRODUCTION:

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.



  1. SUBJECTIVE DATA:

History may include:

  • Contraceptive method; condom/spermicide use

  • Recent use of antibiotics, corticosteroids, or chemotherapy

  • LNMP

- Symptoms may include:

  • Vulvar/vaginal pruritus, soreness, swelling, burning

  • Abnormal vaginal discharge described as thick, white and cheesy

  • Dyspareunia

  • Symptoms may increase just prior to menses

  • History of diabetes mellitus, HIV, or other immunocompromise

III. OBJECTIVE DATA:



Physical exam findings:

  • Females: inspection of vulva, vagina and cervix to assess for:

- abnormal discharge, erythema, swelling, and lesions

  • Males: inspection of penis, coronal sulcus, periurethral area and prepuce to assess for:

- erythema, swelling and irritation



  1. ASSESSMENT:

Diagnosis of candidiasis is made by laboratory testing:

  • a wet preparation (saline, 10% KOH) or Gram stain of vaginal discharge demonstrating yeasts, hyphae, or pseudohyphae

  • a culture or other tests yield a yeast species

V. PLAN:

Treatment :



Recommended Regimens

Over-the-Counter Intravaginal Agents:

Butoconazole 2% cream 5 g intravaginally for 3 days

OR

Clotrimazole 1% cream 5 g intravaginally for 7–14 days

OR

Clotrimazole 2% cream 5 g intravaginally for 3 days

OR

Miconazole 2% cream 5 g intravaginally for 7 days

OR

Miconazole 4% cream 5 g intravaginally for 3 days

OR

Miconazole 100 mg vaginal suppository, one suppository for 7 days

OR

Miconazole 200 mg vaginal suppository, one suppository for 3 days

OR

Miconazole 1,200 mg vaginal suppository, one suppository for 1 day

OR

Tioconazole 6.5% ointment 5 g intravaginally in a single application

Prescription Intravaginal Agents:

Butoconazole 2% cream (single dose bioadhesive product), 5 g intravaginally for 1 day

OR

Nystatin 100,000-unit vaginal tablet, one tablet for 14 days

OR

Terconazole 0.4% cream 5 g intravaginally for 7 days

OR

Terconazole 0.8% cream 5 g intravaginally for 3 days

OR

Terconazole 80 mg vaginal suppository, one suppository for 3 days

Oral Agent:

Fluconazole 150 mg oral tablet, one tablet in single dose (Avoid in Pregnancy)




  1. SPECIAL CONSIDERATIONS:

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).



  1. CLIENT EDUCATION/COUNSELING:

  • Creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms.

  • Provide Medication information sheet

  • Provide STI education information

  • Provide current educational information on vvc

  • Provide contraceptive information if requested

  • VVC is usually not a sexually transmitted disease

VIII. FOLLOW-UP:



  • Unnecessary if asymptomatic after medication treatment

  • Question client on resolution of symptoms at next clinic visit

  • Patients should be instructed to return for follow-up visits only if symptoms persist or recur within 2 months of onset of the initial symptoms

IX. REFERRAL:



X. REPORTING:



  • Mandated state reporting is NOT required in MI

Reference:



  1. CDC: Sexually Transmitted Disease Treatment Guidelines, 2010

  2. Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories, 2013

Revised: 9/2013






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