Infectious DiseasesTier 2Disease (DEADMAN)

Genito-urinary conditions - candidiasis

Description

Vulvovaginal candidiasis is a common, generally non-sexually-transmitted fungal infection driven by Candida albicans overgrowth - distinguished from STI-related discharge by its characteristic thick, curd-like discharge without the typical STI risk-factor pattern

Epidemiology

Extremely common, with most women experiencing at least one episode in their lifetime; recurrent candidiasis (4 or more episodes per year) affects a smaller but clinically significant proportion

Aetiopathogenesis

Disruption of normal vaginal flora/pH (antibiotic use, pregnancy, poorly controlled diabetes, immunosuppression) allows Candida overgrowth from its normal commensal presence - explaining why recent antibiotic use is a classic precipitant

Diagnosis

Clinical diagnosis (thick white "cottage cheese" discharge, vulval itch/soreness, erythema) is usually sufficient; microscopy/culture reserved for atypical, recurrent, or treatment-refractory presentations to confirm diagnosis and exclude resistant species (non-albicans Candida)

Management

Topical or oral azole antifungals (e.g. fluconazole) are first-line for uncomplicated infection
Recurrent candidiasis warrants assessment for underlying predisposing factors (diabetes, immunosuppression) and may require a longer induction-maintenance antifungal regimen

Associations

Diabetes mellitus (poorly controlled - a key predisposing factor), recent antibiotic use, recurrent candidiasis and non-albicans species, pregnancy (topical treatment preferred)

Natural history & complications

Recurrent candidiasis should prompt screening for an underlying predisposing cause (particularly diabetes) rather than simply repeating the same short antifungal course each time - addressing the underlying driver reduces recurrence more effectively than treating each episode in isolation

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