Fast Five Quiz: Vaginal Health

Michel E. Rivlin, MD

Disclosures

October 01, 2021

Traditionally, vulvovaginal candidiasis is not considered a sexually transmitted disease because it occurs in celibate women, and Candida itself is considered part of the normal vaginal flora; however, it is more common among sexually active women.

In acute vulvovaginal candidiasis, vulvar pruritus and burning are the main symptoms. Patients commonly complain of both symptoms after intercourse or upon urination. Dyspareunia may develop and become severe enough to lead to intolerance of intercourse. Physical findings in acute vulvovaginal candidiasis include erythema and edema of the vestibule and of the labia majora and minora. The rash may extend to the thighs and perineum. Thrush patches are usually found loosely adherent to the vulva. A thick, white, curd-like vaginal discharge is usually present.

The clinical picture of chronic, persistent vulvovaginal candidiasis differs in that it includes marked edema and lichenification of the vulva with poorly defined margins. Often, a grayish sheen made up of epithelial cells and organisms covers the area. Symptoms include severe pruritus, burning, irritation, and pain. Patients with chronic candidiasis are usually older and obese and often have long-standing diabetes.

A pelvic examination, pH testing, and other laboratory tests to exclude differential diagnoses are indicated. The cervix is typically not inflamed in vulvovaginal candidiasis, and no cervical motion tenderness or abnormal discharge from the cervical os should be observed. The diagnosis of vulvovaginal candidiasis depends on the demonstration of a species of Candida — as with a wet-mount test or potassium hydroxide preparation — and the presence of clinical symptoms. Vaginal pH usually remains normal in vulvovaginal candidiasis.

Acute vulvovaginal candidiasis is typically treated with azole antifungals that can be taken orally as a single dose or applied intravaginally, with many treatments available over the counter. Patients with recurrent vulvovaginal candidiasis often benefit from 6-month suppressive therapy with weekly oral fluconazole.

Read more on vulvovaginitis.

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