Rule out precipitating factors: Pregnancy, antibiotic therapy, diabetes mellitus, steroid therapy, immunosuppression (i.e. HIV), menstruation, relation to sexual intercourse/condoms, antiseptic or irritant bath additives, vaginal douching, chlorinated swimming pools, tight synthetic underwear
  • Ensure candida has been isolated - if not repeat culture & request "speciation & sensitivity"
  • If no / poor response to antifungals, consider differential diagnoses - probably not candida
  • If candida glabrata isolated use polyene antifungal, eg nystation cream & pessaries, 14-28 days
  • If associated with menstrual cycle consider regular monthly pre-emptive treatment
  • Consider longer duration for first & second line treatment (i.e. 14 days)
  • If severe & responds to fluconazole can use 150mg weekly for 6 months - evidence suggests 50% women will clear candida, 50% will relapse

NB: candida is not an STI - if male partner has symptoms of balanitis (itching, erythematous, speckled rash on glans), this may be a reaction to female partner's candida sp . -treat both partners with clotrimazole preparations.

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