Treatment of Candida Vaginitis During Pregnancy

Topical azole antifungals for 7 days are the recommended first-line treatment for vulvovaginal candidiasis during pregnancy. 1

Diagnosis

Typical symptoms include vulvar pruritus, vaginal discharge, vaginal soreness, vulvar burning, dyspareunia, and external dysuria 1
Diagnosis is confirmed by presence of symptoms plus either wet preparation/Gram stain showing yeast or pseudohyphae or positive culture for Candida species 1
Vaginal pH typically remains normal (≤4.5) with Candida infection 1

Only topical azole therapies should be used during pregnancy 2, 1
Oral antifungal agents (fluconazole, itraconazole) should be avoided, particularly during the first trimester, due to potential teratogenicity 3, 4
Treatment duration should be 7 days during pregnancy rather than shorter courses that might be used in non-pregnant women 5

Topical azole treatments result in relief of symptoms and negative cultures in 80-90% of patients after therapy completion 2, 1
Follow-up is generally unnecessary if symptoms resolve 1
If symptoms persist after treatment, consider alternative diagnoses or resistant organisms 1

Routine treatment of sexual partners is not warranted as vaginal candidiasis is not typically acquired through sexual intercourse 2, 1
Partners with symptomatic balanitis may benefit from treatment with topical antifungal agents 2, 1

Vaginal candidiasis is more common during pregnancy due to hormonal changes 6
Clotrimazole treatment in the first trimester of pregnancy may reduce the rate of premature births 6
For severe vulvovaginitis (extensive vulvar erythema, edema, excoriation, and fissure formation), a longer duration of therapy (7-14 days) is recommended 2
Non-albicans Candida species (particularly C. glabrata) may not respond adequately to standard azole therapy and may require alternative treatments 2, 6

The recommendation for topical azole therapy during pregnancy is based on multiple guidelines and studies showing both efficacy and safety 2, 1, 5
A Cochrane review found that topical imidazoles appear more effective than nystatin for treating symptomatic vaginal candidiasis in pregnancy 5
Recent research confirms that local treatment of VVC has several advantages when compared with oral therapy, including a low rate of adverse events and safe utilization during pregnancy 7

Using oral antifungals during pregnancy, especially in the first trimester 4
Using treatment courses that are too short (less than 7 days) during pregnancy 5
Treating asymptomatic colonization with Candida, which occurs in approximately 20-30% of pregnant women 6
Failing to consider non-albicans species in cases of treatment failure 2, 6