Candida, genital thrush

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. Treatment can be started without doing a high vaginal swab.  A high vaginal swab can be useful in women experiencing recurrent symptoms or failing to respond to treatment in order to confirm the presence of candida and sensitivities where resistance is suspected. Resistance is not common. 
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. Careful consideration should be given to alternative diagnosis such as lichen sclerosis eczema or other dermatological conditions. Referral to GUM or dermatology may be warranted.  The Vulval skin care leaflet from British Association of Dermatology contains general advice for patients.

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.  

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

Patient Information

• Patient information on STIs and genital conditions is available at the HSE Sexual Health and Crisis Pregnancy website
• Thrush Candida PIL 

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed November 2021