Vulvovaginal candidiasis
Candida vulvovaginitis presents with vulvar itching, burning, and thick curdy white discharge at a normal vaginal pH; uncomplicated disease clears with a single 150 mg oral fluconazole dose or a short topical azole course, while complicated or recurrent disease needs a longer induction course followed by suppressive therapy.
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What this article covers
- Overview
Candida vulvovaginitis: symptomatic vulvovaginal infection with a Candida species, most often Candida albicans, causing vulvar itching, burning, and a thick white curdy discharge without a fishy odor.
- Epidemiology
Common across reproductive age: most women have at least one episode of vulvovaginal candidiasis during their lifetime, with peak incidence in the reproductive years.
- Risk factors
Antibiotic use: broad-spectrum antibiotic therapy suppresses protective vaginal lactobacilli and is a well-established precipitant of postantibiotic episodes.
- Pathophysiology
Overgrowth of a normal vaginal commensal: Candida albicans is a dimorphic fungus present in low numbers on skin and mucosal surfaces of healthy women; disease reflects local overgrowth and transition…
- Clinical features
Vulvar itching and irritation: the dominant and most consistent symptom, often the presenting complaint, sometimes with burning that predates any visible discharge.
- Differential diagnosis
Bacterial vaginosis: most common cause of vaginitis; thin homogeneous gray-white malodorous ("fishy") discharge, pH 4.5, positive whiff test, and clue cells on wet mount, unlike the odorless, pH <4.5…
- Diagnosis
Confirmed by potassium hydroxide (KOH) wet mount showing pseudohyphae, hyphae, or budding yeast in a symptomatic woman with a normal (<4.5) vaginal pH and a negative amine (whiff) test; history and…
- Management
First, confirm the diagnosis and classify as uncomplicated or complicated, since the two tiers use different durations and follow-up.
- Complications
Recurrent vulvovaginal candidiasis: the most common complication, 4 or more symptomatic episodes per year, often requiring extended induction plus 6 months of weekly fluconazole maintenance.
- Prognosis
Uncomplicated disease resolves reliably: a single 150 mg oral fluconazole dose or a short topical azole course is curative in most healthy, nonpregnant women with mild-to-moderate symptoms.
- Prevention
Reserve antibiotics for documented bacterial infection to avoid unnecessary suppression of protective vaginal lactobacilli, a recognized precipitant of postantibiotic candidiasis.
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