From the Research
Asymptomatic Vaginal Candidiasis Treatment
- The treatment of asymptomatic vaginal candidiasis is a topic of debate, with some studies suggesting that it is not necessary to treat asymptomatic women 1, 2.
- According to the Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k), neither a woman with asymptomatic colonization nor an asymptomatic sexual partner should be treated 1.
- However, some studies suggest that treatment of asymptomatic vaginal candidiasis may be beneficial in certain situations, such as in the third trimester of pregnancy, to reduce the risk of oral thrush and diaper dermatitis in the newborn 2.
- A study on vaginal colonization by Candida in asymptomatic women found that women with a history of recurrent vulvovaginal candidiasis had more easily detectable Candida in their vagina, even when asymptomatic, than did other women 3.
Treatment Recommendations
- The Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k) recommends that acute VVC can be treated with local imidazoles, polyenes or ciclopirox olamine, using vaginal tablets, ovules or creams 1.
- The guideline also recommends that women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles 1.
- Another study recommends that symptomatic vulvovaginal candidiasis treated with topical azoles may require longer courses of therapy to be resolved 4.
Special Considerations
- In pregnancy, treatment of symptomatic Trichomonas vaginalis with oral metronidazole is warranted for the prevention of preterm birth 4.
- Local treatment is preferred during pregnancy, and vaginal preparations containing polyenes, imidazoles and ciclopiroxolamine or oral triazoles are all equally effective 2.
- However, C. glabrata is resistant to the usual dosages of all local antimycotics, and therefore, vaginal boric acid suppositories or vaginal flucytosine are recommended 2.