Vulvovaginal Candidiasis Diagnosis and Treatment

Clinical Presentation

The Centers for Disease Control and Prevention (CDC) guidelines state that a white discharge may or may not be present in vulvovaginal candidiasis, and the diagnosis is primarily suggested by pruritus and erythema in the vulvovaginal area 1, 2
The key symptoms of vulvovaginal candidiasis include pruritus (itching), vaginal soreness, vulvar burning, dyspareunia (painful intercourse), and external dysuria, with none of these symptoms being specific for the condition 1

The diagnosis of vulvovaginal candidiasis should be made through microscopy or culture, not clinical appearance alone, with wet preparation with 10% KOH or Gram stain demonstrating yeasts or pseudohyphae confirming the diagnosis 1, 2
Culture is more sensitive than microscopic examination when clinical suspicion exists but microscopy is negative 3, 4
A normal vaginal pH (<4.5) is associated with candidiasis, which helps differentiate it from bacterial vaginosis or trichomoniasis 1, 2

The CDC recommends short-course topical azoles or oral fluconazole 150 mg as a single dose for uncomplicated cases of vulvovaginal candidiasis, with treatment based on confirmed diagnosis, not clinical appearance alone 1, 2