What condition does Candida (C.) albicans cause on the inner labia when indicated by a High Vaginal Swab (HVS)?

Vulvovaginal Candidiasis on the Inner Labia

C. albicans detected on a high vaginal swab (HVS) causes vulvovaginal candidiasis (VVC), which presents on the inner labia as pruritus (itching) and erythema (redness), often accompanied by white vaginal discharge. 1

Clinical Presentation on the Inner Labia

• The inner labia (vulvovaginal area) shows erythema and swelling when infected with C. albicans, which is the most characteristic finding on examination 1, 2

• Intense pruritus (itching) is the most specific symptom affecting the vulvovaginal tissues, including the inner labia 1, 2

• Vulvar burning and soreness commonly accompany the erythema on the inner labia 1

• White vaginal discharge may be present, though this is not always visible on the labia themselves 1, 2

Diagnostic Confirmation

• The diagnosis is confirmed when HVS demonstrates yeasts or pseudohyphae on wet preparation with 10% KOH or when culture yields positive results for Candida species 1, 2

• Vaginal pH remains normal (≤4.5) in VVC, which helps distinguish it from other vaginal infections 1, 2

• Important caveat: 10-20% of asymptomatic women harbor Candida in the vagina, so a positive HVS without symptoms does NOT require treatment 1

Treatment When Symptomatic

For uncomplicated VVC with symptoms on the inner labia, use topical azole therapy:

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 1
• Miconazole 2% cream 5g intravaginally for 7 days 1
• Alternative: Fluconazole 150mg oral single dose (though topical therapy directly treats vulvar symptoms) 2, 3

Topical azoles achieve 80-90% cure rates with relief of symptoms and negative cultures 1

Critical Clinical Pitfalls

• Never treat asymptomatic colonization - only treat when the patient has symptoms of pruritus, erythema, or soreness on the inner labia 1

• VVC can occur concomitantly with STDs, so if the clinical picture doesn't fit or symptoms persist, test for other pathogens 1

• In pregnancy, only use 7-day topical azole therapy - never oral fluconazole due to risk of spontaneous abortion and congenital defects 1, 2