Test of Cure for Yeast Infections
Routine test of cure is not recommended for yeast infections—patients should only return for follow-up if symptoms persist or recur within 2 months. 1, 2
When Follow-Up Testing Is NOT Needed
For uncomplicated vulvovaginal candidiasis (VVC), no test of cure is necessary after completing treatment if symptoms resolve completely. 3, 2
The Centers for Disease Control and Prevention explicitly states that patients should be instructed to return for follow-up only if symptoms persist or recur within 2 months, not for routine confirmation of cure. 3, 2
This approach differs markedly from candidemia management, where follow-up blood cultures are mandatory to document clearance. 1
When Follow-Up Testing IS Indicated
Persistent or Recurrent Symptoms
If symptoms persist after treatment or recur within 2 months, obtain vaginal cultures to identify the Candida species and guide further therapy. 2, 4
Wet mount microscopy has poor sensitivity (only 48.5% for VVC), so culture or nucleic acid amplification testing (NAAT) should be performed when symptoms persist despite negative microscopy. 5, 6
Culture is considered the gold standard for identifying vulvovaginal candidiasis in persistent or recurrent cases, with sensitivity of 83.3% compared to 48.5% for wet mount. 5, 6
Complicated or Recurrent VVC
For women with recurrent VVC (≥4 episodes per year), obtain cultures to identify non-albicans species (particularly C. glabrata) that may require alternative therapy. 2, 4
Species identification is critical because C. glabrata and other non-albicans species may be fluconazole-resistant and require boric acid or extended topical therapy. 3, 2
Key Clinical Pitfalls
Do not rely on patient self-reported symptoms alone—symptom scores have high sensitivity (90%) but very low specificity (7%) compared to culture results. 6
Wet mount has low sensitivity (18%) but high specificity (99%), meaning a negative wet mount does not rule out yeast infection in symptomatic patients. 6
Women using over-the-counter preparations who have persistent symptoms or recurrence within 2 months must seek medical evaluation rather than continuing self-treatment. 2
Special Consideration: Candidemia vs. Vulvovaginal Candidiasis
This distinction is critical because the approach differs completely: