QuestionSBA
QuestionChoice
Whilst chlamydia trachomatis is the most common sexually transmitted infection; it typically does not present with a vulval itch. In most women, chlamydia infection is asymptomatic; however, it can cause an unusual vaginal discharge.
49829
c
Chlamydia trachomatis
QuestionChoice
Lactobacilli are part of the normal vaginal flora. Lack of lactobacilli results in bacterial vaginosis, which presents with a smelly discharge and increased vaginal pH.
49831
e
Lactobacillus crispatus
QuestionChoice
Trichomonas vaginalis (TV) causes trichomoniasis, which typically presents with a profuse frothy discharge, vaginitis and a raised pH.
49828
b
Trichomonas vaginalis
QuestionChoice
This woman is presenting with symptoms typical of vulvovaginal candidiasis (thrush). Checking pH can often help in the diagnosis; normal vaginal pH is between 3.8 and 4.5. Higher pH (i.e. >4.5 usually indicates conditions such as bacterial vaginosis or trichomoniasis). Vulvovaginal candidiasis can be triggered by intercourse, and is more common during pregnancy.
49827
a
Candida albicans
QuestionChoice
Mycoplasma genitalium can also cause an unusual vaginal discharge and is sexually transmitted. However, it does not tend to cause an itch, so this is less likely to be the causative organism.
49830
d
Mycoplasma genitalium
Concept
Chapter
# Summary
 

Vulvovaginal candidiasis is a common fungal infection primarily caused by Candida Albicans. This infection affects approximately 20% of women annually and presents with key symptoms like itching, white curdy discharge, and a burning sensation. Risk factors include pregnancy, antibiotic use, and immunosuppression. While routine investigations are not generally recommended for uncomplicated cases, microscopy and culture may be required for recurrent instances or ambiguous symptoms. Management primarily involves antifungal treatments such as oral azoles, intravaginal pessaries, or topical creams. The choice of treatment relies on patient factors and preferences.
 

# Definition
 

Vulvovaginal candidiasis, often referred to as a yeast infection, is an inflammation of the vagina and the vulva due to an overgrowth of the yeast fungus, primarily Candida Albicans.
 

Recurrent vulvovaginal candidiasis is defined as four or more symptomatic episodes in one year, with at least two episodes confirmed by microscopy or culture when symptomatic.
 

# Epidemiology
 

Vulvovaginal candidiasis impacts approximately 20% of women on an annual basis. Despite its high prevalence, the epidemiology of this condition is not well-delineated.
 

# Aetiology
 

Candida Albicans is the main causative organism in 85-90% of vulvovaginal candidiasis cases. Transmission is typically non-sexual.
 

# Risk Factors
 

Key factors that increase the risk of developing a Candida infection include:
 

- Pregnancy
- Antibiotic use
- Immunosuppression
- Type 2 diabetes, use of SGLT-2 inhibitors
 

# Signs and Symptoms
 

Clinical features in both men and women include:
 

- **Women**
- Symptoms: Itching, white curdy or lumpy discharge, sour milk odour, dysuria, superficial dyspareunia, pruritus, tenderness, and a burning sensation.
- Examination findings: Redness, fissuring, swelling, intertrigo, thick white discharge.
- **Men**
- Symptoms: Soreness, pruritus, redness.
- Examination findings: Dry, dull, red glazed plaques and papules.
 

# Differential Diagnosis
 

The following conditions can present similarly to vulvovaginal candidiasis and should be considered:
 

- **Bacterial vaginosis**: Characterised by greyish-white discharge, fishy odour, and absence of significant inflammation.
- **Trichomoniasis**: Presents with yellow-green, frothy discharge, dysuria, and itching.
- **Chlamydia or Gonorrhoea**: These sexually transmitted infections can cause similar symptoms such as discharge, but often also present with pelvic pain or bleeding.
- **Genital herpes**: Characterised by painful blisters or open sores in the genital area.
 

# Investigations
 

Routine investigations are not typically required for acute, uncomplicated vulvovaginal candidiasis cases. However, in instances where the clinical presentation is unclear or recurrent episodes occur, the following investigations may be necessary:
 

- **Microscopy**: Detection of blastospores, pseudohyphae and neutrophils suggests Candida infection.
- **Culture**: Recommended for recurrent vulvovaginal candidiasis cases to identify the Candida species.
 

# Management
 

Vulvovaginal candidiasis is primarily managed with antifungal treatment:
 

- Oral (-azoles) e.g., fluconazole, itraconazole
- Intravaginal e.g., clotrimazole pessary
- Vulval e.g., topical clotrimazole cream
 

Common regimens include:
 

- Fluconazole oral capsule 150mg as a single dose.
- Clotrimazole intravaginal pessary 500mg as a single dose.
- Clotrimazole intravaginal cream (10%) 5g as a single dose.
- Clotrimazole intravaginal pessary 200mg at night for 3 consecutive nights.
 

Recurrent vulvovaginal candidiasis is managed with a induction and maintainence regimen:
 

- Induction with Fluconazole oral capsule 150mg every 72 hours for a total of three doses
- Maintainence with Fluconazole oral capsule 150mg once weekly for six months
 

These regimens can be supplemented with topical -azole therapy if vulval symptoms persist. Treatment choice depends on contraindications, drug history, and patient preference. Oral therapies should be avoided in pregnant women, women at risk of pregnancy, and breastfeeding women. Intravaginal and topical treatments may compromise the integrity of latex condoms and diaphragms.
 

# References
 

[Click here to see information on NICE CKS about candidiasis](https://cks.nice.org.uk/topics/candida-female-genital/)
 

[Click here for BASHH guidelines of vulvovaginal candidiasis](https://www.bashhguidelines.org/media/1223/vvc-2019.pdf)
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Genital candidiasis
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Obstetrics
Video
Concept
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Genital candidiasis
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Quesmed Tutorial: Obstetrics 2
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Concept
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Genital candidiasis
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Genital candidiasis
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A 16-year-old primiparous woman attends her general practitioner with a 2-week history of unusual vaginal discharge, which started the day after unprotected intercourse with her regular male partner. She describes the discharge as white and associated with vulval discomfort and itch. She is approximately 10 weeks pregnant.

On examination, the labia minora are coated with a white discharge, and a lumpy white discharge can be observed inside the vaginal vault on speculum examination. There is no noticeable odour.

Litmus paper, applied to the lateral vaginal wall, indicates a pH of around 4.0.

What is the most likely causative organism?
a