Vaginal candidiasis (thrush)

Prescribing Notes:

• Clotrimazole and fluconazole are available over-the-counter.
• There is no evidence that treating the partner of women suffering from candidiasis is helpful.
• Patients who are inserting intravaginal cream or pessaries into the vagina, may also apply topical clotrimazole cream to the vulva.
• With any genital symptoms always consider the possibility of sexually transmitted infection (STI). People with risk factors should be screened for chlamydia, gonorrhoea, HIV and syphilis. Refer the individual and partners to sexual health service. Risk factors: <25yrs, no condom use, recent (<12mth)/frequent change of partner, symptomatic partner.

Prescribing Notes:

• Vaginal candidiasis (vaginal thrush) is not normally a problem in younger girls (pre-puberty) but can occur in adolescents.
• For girls aged 16 years and older refer to Pharmacy First or Adult ERF recommendations.
• For more information refer to NICE CKS: Candida - female genital and BNFc treatment summary Vulvovaginal candidiasis.

Prescribing Notes:

• There is no evidence that treating an asymptomatic partner/s of women suffering from candidiasis is helpful.
• Patients who are inserting intravaginal cream or pessaries into the vagina, may also apply topical clotrimazole cream to the vulva.
• The application of topical antifungal creams are not always necessary but can be used to treat vulvitis and supplement primary treatment.
• Fluconazole may be used for women aged 16-60 years.
• OTC antifungal treatments cannot be supplied to pregnant women – refer to GP.

Examples of Counselling Points
Avoid strongly perfumed bath additives.
External creams need to be applied for seven days after symptoms have cleared.
Clotrimazole preparations have a damaging effect on latex condoms and diaphragms.

When to advise patient to contact GP
Pregnancy.
Recurrent episodes of infection.
Signs of bacterial infection.
Unresponsive to appropriate treatment.
Diabetic patients.
Vulva pain.
<16 years or >60 years.