Sexual health
AKT · Sexual health/Vaginitis / discharge
Vulvovaginal candidiasis
Candida albicans (yeast)
Overview
Common fungal vaginitis — itch and thick white discharge with a normal vaginal pH. Not an STI; precipitated by antibiotics, diabetes, pregnancy and immunosuppression.
Recognise
- Thick white "cottage-cheese" discharge
- Vulval ITCH and soreness, superficial dyspareunia, external dysuria
- Erythema/fissuring; NORMAL vaginal pH (<4.5)
Red flags
- Recurrent (≥4/year) → check diabetes/immunosuppression; pregnancy (oral azoles avoided)
Differentials & how to tell them apart
Bacterial vaginosisfishy odour, raised pH, no itch — opposite profile
Trichomoniasisfrothy green, raised pH, strawberry cervix
Contact/irritant dermatitisno discharge; exposure history
Investigations
Often clinical. Confirm with high vaginal swab if uncertain/recurrent; normal pH helps distinguish from BV/trichomonas.
Management
Fluconazole 150 mg oral capsule single dose
- 1Acute: fluconazole 150 mg oral single dose first-line.Gate: Oral fluconazole is contraindicated in pregnancy → use a clotrimazole 500 mg pessary (intravaginal)
- 2Pregnancy: topical imidazole (clotrimazole pessary ± cream); avoid oral azoles.
- 3Recurrent (≥4/yr): induction + maintenance azole regimen; investigate diabetes/immunosuppression.
Fluconazole — first-line oral; 150 mg single dose; NOT in pregnancy
Clotrimazole pessary — intravaginal if oral contraindicated/pregnant; 500 mg single
Key points
Topical azoles can damage latex condoms/diaphragms. Recurrent disease → exclude diabetes.
Monitor & prognosis
Symptom resolution; recurrence work-up if frequent.
Benign; recurrences manageable.
Source: NICE CKS Candida - female genital (2025)