Management of chronic vulvovaginitis caused by Candida and related species in adults

Chronic vulvovaginitis symptoms caused by Candida and related species, which may improve during menses and remit with imidazole or nystatin therapy, are now recognised as a distinct conditionHong, 2014Saxon, Edwards, Rautemaa-Richardson, Owen, Nathan, Palmer, Wood, Ahmed, Ahmad Patient Representatives, , 2020. It is more commonly seen in younger adults (usually 20 to 25 years old, but teenagers can also be affected). Chronic vulvovaginitis caused by Candida and related species is usually cyclical, although it can also be continuousNguyen, 2017. It is considered an irritant dermatitis to Candida and related species.

Perform an external examination to exclude alternative or co-existing vulval pathologies, and take a high vaginal swab for microscopy, culture and sensitivity to confirm the diagnosis; see Assessment of vulvovaginitis caused by Candida and related species in adults. If chronic vulvovaginitis caused by Candida and related species is suspected, consider referring the patient to a gynaecologist or dermatologist. Specialised vulvar disorder clinics are available in some areas.

Long-term therapy with an oral azole (eg fluconazole) may be prescribed by the gynaecologist or dermatologist to reduce the Candida yeast load (which reduces the irritation)Nguyen, 2017, but consideration must be given to the potential for antifungal resistance with protracted regimensPerlin, 2015Saxon, Edwards, Rautemaa-Richardson, Owen, Nathan, Palmer, Wood, Ahmed, Ahmad Patient Representatives, , 2020.

If an oral antibiotic is needed for a concurrent infection, inform the patient that chronic vulvovaginitis caused by Candida and related species may flare. After completing antibiotic therapy, the patient may also need antifungal therapy.