Candidiasis

Asymptomatic

Usual Pathogens

Candida spp
Occasionally non-C. albicans yeast

 

Treatment not necessary if asymptomatic

Symptomatic, uncomplicated

Criteria for uncomplicated infections: 

  • sporadic or infrequent vulvovaginal candidiasis
  • mild-to-moderate vulvovaginal candidiasis
  • likely to be C. albicans
  • nonpregnant.

- Treat male partner (only if Candida balanitis present) with topical azole bid x 7 days or fluconazole 150 mg po single dose.

 
Usual Pathogens

Candida spp

 

Therapy Dose Duration
Fluconazole 150mg PO

1 dose

or    
Clotrimazole 2% cream 5g intravag hs 3 days
or    
Clotrimazole 10% cream 5g intravag hs 1 dose
or    
Clotrimazole tablet 200mg intravag hs or 3 days
  500mg intravag hs 1 dose
or    
Miconazole ovule 1200mg intravag hs or 1 dose
  400mg intravag hs 3 days
or    
Miconazole 4% cream 5g intravag hs 3 days
or    
Terconazole 0.4% cream 5g intravag hs 7 days

 

Symptomatic, complicated

Criteria for complicated infections:

  • severe vulvovaginal candidiasis
  • recurrent vulvovaginal candidiasis
  • non-albicans candidiasis
  • pregnant
  • abnormal host (e.g. uncontrolled diabetes, debilitation, or immunosuppression) 

Severe

Canadian Guidelines on Sexually Transmitted Infections - Vaginal Discharge

 
Usual Pathogens

Candida spp
Occasionally non-C. albicans yeast

 

Therapy Dose Duration

Fluconazole

150mg PO q72h 2 doses
or    
Intravaginal azole See Symptomatic-Uncomplicated above 10-14 days

Recurrent

(≥4 episodes in 12 months)

 

Usual Pathogens

Candida spp
Occasionally non-C. albicans yeast

Induction treatment

Therapy Dose Duration
Fluconazole 150mg PO q72h 3 doses
or    
Intravaginal azole See Symptomatic-Uncomplicated above 10-14 days
or    

Boric acid

300-600mg intravag daily 14 days

+

Maintenance treatment

Therapy Dose Duration
Fluconazole 150mg PO weekly minimum 6 months
or    
Clotrimazole tablet 500mg intravag monthly minimum 6 months
or    
Boric acid 300mg intravag daily x first 5 days of menstrual cycle minimum 6 months

 

Pregnancy

Usual Pathogens

Candida spp
Occasionally non-C. albicans yeast

 

Therapy Dose Duration
Clotrimazole 2% cream 5g intravag hs 7 days
or    
Clotrimazole tablet 200mg intravag hs 7 days
or    
Miconazole 4% cream 5g intravag hs 7 days
or    
Miconazole ovule 400mg intravag hs 7 days

 

Compromised host

Usual Pathogens

Candida spp
Occasionally non-C. albicans yeast

 

Therapy Dose Duration
Intravaginal azole See Symptomatic-Uncomplicated above 10-14 days
or    
Boric acid 600mg intravag daily 14 days