Candida, genital thrush

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

Comments from Expert Advisory Committee

  1. Candida can lead to genital symptoms in men and women. Asymptomatic colonisation is common. The majority of cases are caused by Candida albicans
  2. In women it can lead to vulvitis, vaginitis or vulvovaginitis. Symptoms include vulval discomfort and itch and vaginal discharge which can be white, thick and curdy in nature
  3. In men it can present with a balanitis with an associated itch.
  4. The diagnosis can be made clinically on the basis of the description and appearance of the vulva, vaginal discharge or glans penis in men. The diagnosis of vaginal candidiasis can be confirmed on high vaginal swab.
  5. In women, consider sexually transmitted causes of vaginal discharge on the basis of sexual history and consider testing for chlamydia and gonorrhoea.
  6. The definition of recurrent vulvovaginal candidiasis is accepted as four or more documented episodes per year.

Treatment Options

Patients should be advised to avoid tight fitting clothing and the use of soaps and shower gels. The use of emollient creams and 1% hydrocortisone may ease symptoms of vulvitis and balanitis. Topical and oral treatments have similar efficacy. Oral azoles should be avoided in pregnancy.

There are many treatment options available, the table below is not exhaustive.

Treatment Conditions
Vulvovaginal candidiasis Clotrimazole pessary 500mg
PV stat 200mg PV x 3 nights

Oral and topical treatments have
equal efficacy
Oral treatment is more expensive
and Fluconazole (and all oral azoles)
should be avoided in pregnancy

Fluconazole 150mg PO stat

Recurrent vulvovaginal

Fluconazole 150mg days 1, 4
and 7 then weekly x 6 months

Candida balanitis

Clotrimazole 1% cream twice
daily topically x 5-7 days
Oral treatment rarely indicated

Oral and topical treatments have equal efficacy. Oral treatment is more expensive and Fluconazole (and all oral azoles) should be avoided in pregnancy

We recommend patients use the website developed by HSE/ICGP/IPU partnership for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Useful resources

Patient Information

Downloadable information on STIs and genital conditions and leaflet to order

 Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Reviewed June 2017

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