27th June 2023

Fungal STIs

Candidiasis

Vulvovaginal candidiasis (VVC) is not an STI but can be more common in those who are sexually active. It is very common, particularly between menarche and menopause, due to its association with vaginal exposure to oestrogen. VVC is caused by the yeast Candida albicans in the vast majority of those affected, but other non-albicans species, e.g. C. glabrata, C. tropicalis or C. krusei, can less commonly be implicated.

The most common symptoms include vulval itch and irritation, dysuria, curd-like discharge, and superficial dyspareunia. There may be evidence of erythema, excoriation, fissuring and discharge on examination. Diagnosis can be made via immediate microscopy, which can demonstrate pseudohyphae and spores. The highest sensitivity and specificity for diagnosis is through culture of Candida.

Affected individuals should be advised to avoid local irritants, such as perfumed soaps, and to wear cotton underwear. Treatment is with antifungals, such as clotrimazole (topical and/or vaginal pessary), or oral fluconazole. It should be explained that latex condoms and diaphragms may be damaged by the topical or vaginal preparations.