Vulvovaginal candidiasis: Treatment of recurrent infection in pregnancy

VVC infection is not associated with adverse pregnancy outcomes but is treated to relieve symptoms. Pregnant patients are only treated with topical antifungals; we do not use oral fluconazole, oteseconazole, and ibrexafungerp because of concerns for potential fetal harm.

VVC: vulvovaginal candidiasis; RVVC: recurrent vulvovaginal candidiasis; BV: bacterial vaginosis.

* Appropriate diagnostic tests for VVC:

pH and microscopy of vaginal discharge
or
DNA probe tests, nucleic acid amplification tests (NAATs),or polymerase chain reaction methods. (Availability varies by institution.)

¶ Laboratory testing is critical for patients with recurrent infection to identify non-albicans Candida species or azole-resistant organisms (uncommon). (Refer to UpToDate content for discussion of treating patients with non-albicans or drug-resistant species.)

Δ Topical antifungal creams are available in other concentrations and their use is reasonable. If using a higher concentration topical azole, duration of induction treatment may be shorter (eg, clotrimazole 2% cream once daily for three to five days). Antifungal creams can also be applied externally, up to two times a day, for symptom relief.

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Vulvovaginal candidiasis: Treatment of recurrent infection in pregnancy