Treatment of Sexual Partners in Vulvovaginal Candidiasis
Routine treatment of male sexual partners is not recommended for women with vulvovaginal candidiasis, as VVC is not typically sexually transmitted and partner treatment does not reduce recurrence rates. 1, 2
Evidence Against Routine Partner Treatment
The pathogenesis of VVC involves overgrowth of Candida species in the vagina rather than sexual transmission, making it fundamentally different from sexually transmitted infections like trichomoniasis. 2 Multiple CDC guidelines consistently state that VVC is not normally acquired through sexual intercourse. 1
A randomized controlled trial directly tested this question and found no benefit: When male partners of women with recurrent VVC were treated with ketoconazole versus placebo, recurrence rates were identical at 6 months (71% vs 65%) and at 1 year (82% vs 85%). 3 This high-quality evidence demonstrates that partner treatment does not prevent recurrence even in the most challenging cases.
When Partner Treatment IS Indicated
Treat male partners only if they are symptomatic with balanitis. 2, 4 Symptomatic male partners may present with:
- Erythematous areas on the glans penis 2, 4
- Pruritus or irritation of the penile area 2
- Visible inflammation or discomfort 4
For symptomatic male partners, use topical antifungal therapy:
- Miconazole 2% cream applied twice daily for 7 days, OR 4
- Clotrimazole cream for 7 days, OR 1
- Tioconazole 6.5% ointment as a single application 4
The goal of treating symptomatic partners is to relieve their symptoms, not to prevent recurrence in the female partner. 2
Special Consideration for Recurrent VVC
For women with recurrent VVC (4 or more episodes per year), partner treatment may be considered, though evidence supporting this approach is limited. 1, 2 However, the randomized trial showing no benefit specifically studied this recurrent population, suggesting even here partner treatment is unlikely to help. 3
The more effective approach for recurrent VVC is maintenance antifungal therapy for the woman herself: 1, 5
- Fluconazole 100-150 mg once weekly for 6 months, OR 1, 5
- Clotrimazole 500 mg vaginal suppository once weekly 1
Common Pitfall to Avoid
Do not confuse VVC management with trichomoniasis management. Unlike candidiasis, trichomoniasis requires mandatory partner treatment because it is sexually transmitted, with cure rates improving from 88% to higher levels when partners are treated. 5 Patients should avoid sexual activity until both partners complete treatment for trichomoniasis. 1