Vaginal candidiasis ('thrush') is an extremely common condition which many women diagnose and treat themselves. Around 80% of cases of Candida albicans, with the remaining 20% being caused by other candida species.

Risk factors:

The majority of women will have no predisposing factors. However, certain factors may make vaginal candidiasis more likely to develop:

• diabetes mellitus
• drugs: antibiotics, steroids
  • Often precipitated by recent antibiotic exposure
• pregnancy
• immunosuppression: HIV

PC

• white (cottage cheese), non-offensive discharge
• vulvitis: superficial dyspareunia, dysuria
• itch
• vulval erythema, fissuring, satellite lesions may be seen

Investigations

• a high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis
• Consider investigations to confirm the diagnosis and/or exclude an alternative diagnosis if there is diagnostic uncertainty, or persistent or recurrent symptoms, depending on clinical judgement.
  • Hba1c to exclude diabetes in women with recurrent vaginal candida

Management