Treatment of Asymptomatic Candida Colonization
No, asymptomatic vaginal Candida colonization should not be treated in healthy, non-pregnant women. 1
General Principle for Non-Pregnant Women
Treatment is only indicated when symptoms are present. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention explicitly recommend against treating asymptomatic colonization, as approximately 10-20% of women harbor Candida without symptoms, and this does not require treatment. 1
Approximately 20% of healthy women with estrogenized vaginas are colonized with Candida species without any symptoms or signs of infection. 2, 3
The diagnosis of vulvovaginal candidiasis requires both typical symptoms (vulvar pruritus, vaginal discharge, vaginal soreness, vulvar burning, dyspareunia, or external dysuria) AND microscopic evidence of yeast/pseudohyphae or positive culture. 1
Treatment of asymptomatic partners is also not warranted, as vaginal candidiasis is not typically acquired through sexual intercourse. 1
Important Exception: Late Pregnancy
In the third trimester of pregnancy (last 6 weeks), antifungal treatment of asymptomatic colonization is recommended in Germany and some other countries to reduce vertical transmission and decrease the risk of oral thrush and diaper dermatitis in the newborn. 4, 3
This recommendation is specific to late pregnancy and aims to prevent neonatal complications rather than maternal symptoms. 4
Only topical azole therapies for 7 days should be used during pregnancy; oral antifungals are contraindicated. 1
Clinical Pitfalls to Avoid
Do not treat based on culture results alone - many women have positive cultures without symptoms, and this represents normal colonization rather than infection requiring treatment. 1, 3
Avoid unnecessary over-the-counter self-treatment - studies show high rates of inappropriate self-diagnosis and treatment, which should be discouraged. 3
Only less than 35-40% of women with genital itching actually have vulvovaginal candidiasis, so symptoms alone are insufficient for diagnosis without microscopic confirmation. 3