4.Whatisthemanagementforthiscase?

For the treatment of vulvovaginal candidiasis, the Center for Disease

control (CDC) recommends placing the woman into an uncomplicated or
complicatedcategorytoguidetreatment.Inthiscase,thepatientcanbeclassified
undertheuncomplicatedcategory.

A number of azole vaginal preparations and a single oral agent,

fluconazole, are approved for treatment. In patients with uncomplicated
vulvovaginalcandidiasis,topicalantifungalagentsaretypicallyusedfor1to3
days,orasingleoraldoseoffluconazole.Patientpreference,responsetoprior
therapy,andcostshouldguidethechoiceoftherapy.
Forpatientswithcomplicatedvaginitis,topicalazolesarerecommendedfor
7to14days.Ifusingoraltherapy,aseconddoseoffluconazole(150mg)given72
hoursafterthefirstdoseisrecommended.
In women with recurrent vulvovaginal candidiasis, the resolution of
symptoms typically requires longer duration of therapy. Seven to 14 days of
topicaltherapyorthreedosesoforalfluconazole3daysapart(e.g.,days1,4,and
7)areoptions.Afterthisinitialtreatment,maintenancetherapywillhelpprevent
recurrence of symptoms. Oral fluconazole (e.g., 100, 150, or 200mg dose)
weeklyfor6monthsistypicallyfirstlinetreatment.However,topicaltreatments

usedintermittentlyasamaintenanceregimenmaybeconsidered.Womenwith
recurrent vulvovaginitis should receive a vaginal fungal culture to determine
speciesandsensitivities.
Infections with Candida spp. other than C. albicans are often azole
resistant.However,onestudyofterconazolefornonC.albicansfungalvaginitis
resultedinamycologiccurein56%ofpatientsandasymptomaticcurein44%of
women.Vaginalboricacidcapsules(600mginOgelatincapsules)areanother
option. In one study, treatment for a minimum of 14 days resulted in a
symptomaticcurerateof70%forwomenwithnonC.albicans infection.Boric
acid inhibits fungal cell wall growth. It may also be used for suppression in
womenwithrecurrentvulvovaginalcandidiasis.Following10daysoftherapy,one
600mg capsule intravaginally twice weekly for 4 to 6 months decreases
symptomaticrecurrences.Boricacidistoxicifingested,soitshouldbestoredina
safemanner.
Studiesofalternativetherapiesforvulvovaginalcandidiasis(suchasoralor
vaginalLactobacillus,garlic,ordietalterationssuchasyogurtingestion)donot
showefficacy.
Below is the summary of treatment options provided for Candidiasis
recommendedbyCDC.