Asymptomatic disease does not need treatment.
Any of the available imidazole preparations are effective, either as cream or pessaries. Various preparations are available for either single dose therapy, or three to seven days of therapy.
Prolonged use should be avoided as contact dermatitis may result.
Where there is severe vulvitis or balanitis associated with candidiasis, one per cent hydrocortisone preparations may be given with antifungal therapy to resolve symptoms. Unopposed steroids may make the condition worse.
Vaginal creams and pessaries may weaken latex condoms and diaphragms.
Oral therapy should be reserved for resistant or recurrent cases. These are expensive treatments and are no more effective than topical preparations for uncomplicated infections:
- fluconazole 150 mg orally, as a single dose (not on PBS but available over the counter)
- ketoconazole* 200 mg orally, 12-hourly with food for five days.
Topical treatment must be used for 12–14 days in pregnancy because of lower response rates and more frequent relapse. Systemic treatment should be avoided. Both fluconazole and ketoconazole are contraindicated in pregnancy.
Medicines in pregnancy.
Some strains of candida are more resistant to treatment than others. In cases of refractory candidiasis the fungus should be speciated. Candida glabrata which has failed treatment with imidazoles can be treated with boric acid 600 mg pessaries per vagina (one per night) for two weeks. These need to be manufactured. Seek specialist advice.
* Ketoconazole can cause hepatotoxicity and has important interactions with other drugs.