Candida (Candidiasis as an STI)

Definition

• Candidiasis is a fungal infection caused by the overgrowth of Candida species, predominantly Candida albicans

• Not classified as a classic sexually transmitted infection, but may occur following sexual activity and be influenced by host factors

Aetiology and Pathogenesis

• Overgrowth results from disruption of the normal microbial flora

• Hormonal changes, antibiotic use and immunosuppression facilitate Candida proliferation

• Non-albicans species can contribute to recurrent cases

Risk Factors and Triggers

• Recent antibiotic use disrupting vaginal flora and reducing lactobacilli

• Excess moisture from tight clothing or inadequate hygiene promoting fungal growth

• Pregnancy with increased glycogen deposition in the vaginal epithelium

• Diabetes mellitus with poor glycaemic control creating an optimal environment

• Combined oral contraceptive pills influencing hormonal balance

• Underlying immunosuppression or other comorbidities increasing susceptibility

Clinical Presentation

• Vulvovaginal itching or burning

• Thick, white, curd-like vaginal discharge

• Erythema and swelling of the vulva

• Dysuria or dyspareunia during urination or intercourse

• Recurrent irritation in patients with multiple episodes

Diagnosis

• Primarily based on clinical history and examination findings

• Microscopy and culture recommended in atypical or recurrent presentations

• Differential diagnosis includes bacterial vaginosis, trichomoniasis and other vulval dermatoses

Management

Non-Pharmacological Management

• Advise wearing loose, breathable clothing to reduce moisture

• Promote good genital hygiene and avoid scented soaps or douching

• Emphasise optimal glycaemic control in diabetic patients

• Educate on cautious antibiotic use to prevent flora disruption

Pharmacological Treatment

• Topical antifungals such as clotrimazole cream or pessaries as first-line for uncomplicated cases

• Oral antifungal therapy, for example a single dose of fluconazole, for severe or recurrent infections

• Consider maintenance therapy in cases of recurrent vulvovaginal candidiasis

• In pregnancy, prefer topical treatments to minimise systemic exposure

Complications and Prognosis

• Recurrent vulvovaginal candidiasis defined as four or more episodes per year

• Risk of secondary bacterial infections due to scratching or epithelial disruption

• Full resolution expected with appropriate treatment and trigger management

• Recurrent cases warrant evaluation for underlying systemic conditions

Notes

• Although not typically sexually transmitted, candidiasis may coincide with other infections or risk factors seen in STI assessments

• Evaluate for co-infections and consider partner assessment where indicated

• In recurrent cases, investigate for underlying immunosuppression or metabolic disorders

• Be aware of potential antifungal resistance, especially with non-albicans species

• Patient education on lifestyle modifications and trigger avoidance is crucial to preventing recurrence