First line:

Avoid oral azoles in pregnancy.

Fluconazole oral 150mg as a single dose

Second line:

Clotrimazole by vagina:

• 500mg vaginal pessary single application or 10% vaginal cream 5g for 14 nights
• In pregnancy: 100mg vaginal pessary once daily for 7 days

Note: Topical clotrimazole damages latex condoms and diaphragms.

Recurrent vulvo-vaginal candidiasis (>4 episodes per year):

Fluconazole oral 150mg every 72 hours for three doses (induction), followed by 150mg once a week for six months (maintenance)

• NICE provides a useful clinical knowledge summary on this topic.
• Symptoms include genital pruritus, external dysuria, swelling or redness. On examination, there may be vulval oedema, fissures, excoriation, or thick curdy discharge. The normal vaginal pH is usually <4.5.
• Only treat symptomatic patients. Treatment of asymptomatic male sexual partners is of no benefit.
• Microscopy and culture are not required in women with typical vulvo-vaginal candidiasis. Send samples for culture in severe cases, treatment failure, recurrent thrush or if the diagnosis is uncertain. In patients with recurrent thrush, consider the possibility of underlying diabetes mellitus or immunocompromise.
• General advice: Avoid tight fitting synthetic clothing. Avoid local irritants e.g. perfumed products. For further information refer to the West of Scotland Sexual Health Managed Clinical Network guidelines.