Thrush diagnosis
As a type of vaginitis, thrush symptoms include inflammation with vulvovaginal reddening, tissue damage, and swelling. A thick, white, non-offensive discharge, likened to cottage cheese in appearance, is a key characteristic. Sensations include itching and irritation, with soreness or stinging possible when urinating or during sex (dyspareunia).24,26,30
There may be a cyclical element to symptoms, but signs and symptoms can differ widely from woman to woman, especially in longer-lasting infections, and cannot be used to indicate which Candida spp is the cause of the infection.24
Diagnosis based on signs, symptoms and microscopy and culture analysis of a vaginal sample needs to consider differential diagnoses such as contact dermatitis or eczema, and non-infectious causes of itching, pain or inflammation.
Thrush management
Oral azoles (eg fluconazole or itraconazole) and intravaginal imidazoles (eg clotrimazole or econazole) are the standard treatments options for VVC. Treatment can be supplemented with an antifungal cream for vulvitis. Ketoconazole is not recommended for treating VVC.24,31
BASHH guidelines for first line drug therapy in acute VVC are either a single oral dose of fluconazole 150mg or a single intravaginal dose of clotrimazole 150mg.24
Alternative azole options are:24
· intravaginal – clotrimazole, econazole, fenticonazole or miconazole
· orally – itraconazole
For severe VVC, oral fluconazole 150mg on day 1 and 4 is the first line option. Alternatively a clotrimazole pessary 500mg on day 1 and 4 or a miconazole pessary 1200mg on day 1 and 4 is recommended.
For recurrent VVC, the recommended route is oral fluconazole 150mg every three days for three doses with a maintenance dose of one 150mg capsule each week for 6 months. Alternatively, start with a topical imidazole therapy for one or two weeks, and then maintain for six months with an intravaginal clotrimazole 500 mg weekly or oral itraconazole 50mg-100mg daily.
Oral azoles should be avoided in pregnancy and breastfeeding. Intravaginal and topical treatments may damage latex condoms and diaphragms. Topical imidazoles may cause local irritation which could be mistaken for treatment failure.24,31