Vaginal Yeast Infection Diagnosis and Management

Clinical Presentation and Diagnosis

Vaginal itching is the most specific symptom of vulvovaginal candidiasis (VVC) and may be the only complaint in some cases 1
Other common symptoms that may or may not be present include vaginal soreness, swelling, and burning, dyspareunia, dysuria, and vaginal discharge (typically thick, white, and resembling cottage cheese) 2
Proper diagnosis should include laboratory confirmation through microscopy, culture, or newer molecular assays 1, 2
Vaginal pH testing can help differentiate VVC (typically ≤4.5) from other causes of vaginitis 4

Confirmation of diagnosis is recommended before treatment, especially for first episodes 2, 3
For pregnant women, only topical azoles are recommended 4
Approximately 10-20% of women normally harbor Candida species in the vagina without symptoms, so treatment should be based on both symptoms and laboratory findings 3
Recurrent vulvovaginal candidiasis (≥4 episodes/year) requires a different management approach with maintenance therapy 3
In patients with HIV infection, VVC may be more severe but treatment measures are identical to those for women without HIV 1