Treatment of Candidiasis in Female Partners
Routine treatment of female sexual partners is not recommended for vulvovaginal candidiasis, as this condition is not sexually transmitted and partner treatment does not reduce recurrence rates. 1
Key Management Principle
Vulvovaginal candidiasis (VVC) is not acquired through sexual intercourse. 1 The evidence clearly demonstrates that:
- Treatment of sex partners has not been shown to reduce the frequency of recurrences in women with VVC 1
- Routine notification or treatment of sex partners is not warranted 1
- Sexual activity may contribute to recurrence, but studies have not established that treating male partners impacts recurrence rates 2
When Female Partners Should Be Treated
Female partners should only be treated if they develop their own symptomatic vulvovaginal candidiasis. 1 If a female partner presents with symptoms, she should be evaluated and treated based on her own clinical presentation:
For Uncomplicated VVC (90% of cases):
- Single-dose oral fluconazole 150 mg is highly effective 1, 3
- Alternative topical options (all equally effective): 1
- Clotrimazole 500 mg vaginal tablet as single dose
- Miconazole 200 mg suppository for 3 days
- Terconazole 0.8% cream for 3 days
- Any OTC azole preparation for 7 days
For Complicated VVC (10% of cases):
- Extended therapy for 7-14 days is required for severe symptoms, recurrent disease, non-albicans species, or immunocompromised hosts 1, 4
- Fluconazole 150 mg every 72 hours for 2-3 doses for severe acute VVC 4
For Non-albicans Species (particularly C. glabrata):
- First-line: Intravaginal boric acid 600 mg daily for 14 days 1, 5
- Alternative: Nystatin 100,000 units intravaginal suppository daily for 14 days 1, 5
- Azole therapy is unreliable for C. glabrata 1, 5
Critical Diagnostic Considerations
Before treating any female partner, confirm the diagnosis: 4
- Wet-mount preparation with saline and 10% KOH to demonstrate yeast or hyphae
- Vaginal pH should be 4.0-4.5 (higher pH suggests bacterial vaginosis or trichomoniasis)
- Vaginal cultures for negative microscopy or suspected non-albicans species
Common Pitfall to Avoid
Self-diagnosis of yeast vaginitis is unreliable. 1 Incorrect diagnosis results in overuse of topical antifungal agents with subsequent risk of contact and irritant vulvar dermatitis. Women whose symptoms persist after OTC treatment or who experience recurrence within 2 months should seek medical evaluation rather than continued self-treatment. 1
Special Population Considerations
- Pregnancy: Only topical azole therapy for 7 days; oral fluconazole is contraindicated 4
- HIV-positive women: Treatment approach should not differ; identical response rates are expected 5, 4
- Recurrent VVC (≥3 episodes/year): After acute treatment, maintenance therapy with fluconazole 150 mg weekly for 6 months 1, 4