Recurrent Vulvovaginal Candidiasis (rVVC)

Please take note of the following before prescribing:

1. Growth of yeast from any superficial or vaginal swab likely represents colonisation in the absence of clinical signs and symptoms of VVC; it is not in itself a diagnosis of VVC or rVVC. Please ensure you have examined the patient and made the diagnosis before embarking on treatment.
2. Review BASHH Vulvovaginal Candidiasis guidelines for latest evidence based management guidance including self-management interventions that should be used in conjunction with antifungal therapy.
3. Women with immunocompromising conditions, receiving regular steroid treatment or with poorly controlled diabetes may require specialist sexual health (GUM) or gynaecological input in recurrent VVC.
4. Women with severe VVC/rVVC should be referred to a specialist in sexual health (GUM) or gynaecology (consider patient preference) for urgent review and treatment. Please reference if first, second and/or third line empirical therapy has been issued and if it has had any positive effect or failed. Full history of treatment should be included clearly on the referral with names and dates of treatments used. Referral information is available on MARG and is the same for both GUM and Gynaecology.
5. Pregnant/Breastfeeding: Avoid oral fluconazole and boric acid; preferentially choose an appropriate topical/pessary therapy.
6. Boric and Nystatin pessaries are unlicensed and as such may take 5-7 days for most community pharmacies to acquire the treatments. Please inform the patient of this delay.
7. Fluconazole resistance in normally-susceptible Candida species is rare. The microbiology laboratory can test isolates within 5 days of an issued report on the advice of a GUM, O&G or an infection specialist (microbiology or ID) only after all empirical therapy options have failed. Email the laboratory with patient details along with the report number to fv.microbiology@nhs.scot
8. Review the need for contraception based on therapy advised/prescribed. Boric acid and clotrimazole – latex condoms and diaphragms can be damaged by these agents. Boric acid may reduce efficacy of vaginal spermicides.

Prescribing for Category A Isolates – Organisms usually susceptible to Fluconazole [See report comment]

e.g. C albicans, C dubliniensis, C tropicalis, S cerevisiae, C parapsilosis, C lusitaniae, C kefyr

Prescribing for Category B/C Isolates – Organisms likely to fail Fluconazole therapy [See report comment]

e.g. C glabrata, C guilliermondii  /  C krusei, C auris