Candidiasis
Asymptomatic
Usual PathogensCandida 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 | |
| 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 |
|---|---|---|
| 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 | ||
| 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 PathogensCandida 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 PathogensCandida 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 |