Fungal infection—~20% of patients are asymptomatic. Predisposing factors include:
• Cushing’s or Addison’s disease
• Broad-spectrum antibiotics
• Steroid treatment
• Vaginal trauma
Presentation: Well, pruritus vulvae, superficial dyspareunia, and/or thick, creamy, non-offensive discharge. Examination: discharge (cottage cheese) and sore vulva which may be cracked/fissured. Investigation is usually unnecessary. Confirm diagnosis if infection persists or recurs by sending a
swab from the anterior fornix for M,C&S.
Management: Only treat if symptomatic. Sexual transmission is minimal; there is no benefit from treating the partner unless overt infection:
• Try clotrimazole pessaries—cure rate ~90%
• Alternative is oral fluconazole stat, repeated after 3d if severe infection. Contraindicated in pregnancy or lactation—83% cure rate.
Recurrent infection: Advise loose, cotton underwear and avoidance of soaps, perfumes, or disinfectants in the bath. Consider vulval emollients to treat associated dermatitis. If >4 documented episodes (>2 confirmed with microbiology) in a year, treat with fluconazole.