What is the treatment for a 20-year-old female with group B streptococcus (GBS) and candida vaginal infection?

From the Guidelines

For a 20-year-old female with both Group B Streptococcus (GBS) and candida vaginal infection, a dual treatment approach is needed, with fluconazole 150 mg as a single oral dose being effective for the candida infection, as recommended by the 2022 guidelines 1.

Treatment Approach

For the GBS infection, oral penicillin V 500 mg four times daily for 7-10 days is recommended, or amoxicillin 500 mg three times daily for the same duration. If the patient has a penicillin allergy, clindamycin 300 mg orally four times daily for 7 days is an alternative.

• The patient should complete the full course of antibiotics even if symptoms improve quickly.
• The patient should avoid sexual intercourse during treatment or use condoms to prevent reinfection.
• GBS requires antibiotic treatment because it can cause urinary tract infections and, in pregnant women, can be transmitted to newborns during delivery.
• Candida infections often occur after antibiotic use disrupts normal vaginal flora, so taking probiotics during antibiotic treatment may help maintain vaginal health.

Candida Infection Treatment

For the candida infection, the following treatments are effective:

• Fluconazole 150 mg as a single oral dose 1.
• Topical antifungal treatments like miconazole or clotrimazole vaginal cream or suppositories for 3-7 days 1.

Follow-up Evaluation

If symptoms persist after treatment, a follow-up evaluation is necessary to rule out other conditions or antibiotic resistance. It's essential to note that the treatment approach should prioritize the patient's quality of life, morbidity, and mortality, and the chosen treatment should be based on the most recent and highest-quality evidence available 1.

From the Research

Treatment for Group B Streptococcus and Candida Vaginal Infection

The treatment for a 20-year-old female with group B streptococcus (GBS) and candida vaginal infection involves addressing both conditions simultaneously.

• For candida vaginal infection, treatment options include:
  • Oral fluconazole 2
  • Topical azoles, which are recommended during pregnancy 2
• For GBS, there is no specific treatment guideline, but treatment with oral penicillin or vaginal clindamycin cream has been reported to result in rapid cure in cases of group A streptococcal vaginitis 3
• In cases with severe atrophy component, local estrogens can be used, and in postmenopausal or breast cancer patients with a contraindication for estrogens, a combination of probiotics with an ultra-low dose of local estriol may be considered 4
• It's essential to note that the coassociation between GBS and Candida albicans promotes interactions with vaginal epithelium, which may serve to promote their cocolonization of the vaginal mucosa 5

Considerations for Treatment

• Antibacterial therapy, whether systemic or locally applied to the vagina, represents the single most frequent and predictable cause or triggering mechanism of symptomatic vulvovaginal candidiasis (VVC) 6
• Treatment of GBS and candida vaginal infection should be based on microscopy findings and may require a combined local treatment with antibiotics, steroids, and/or estrogen 4
• In cases with Candida present on microscopy or culture, antifungals must be tried first to see if other treatment is still needed 4