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Chapter 10 - Myths and Pearls

Published online by Cambridge University Press:  10 August 2023

Gayle Fischer  and
Jennifer Bradford
Gayle Fischer
Affiliation:
University of Sydney
Jennifer Bradford
Affiliation:
University of Western Sydney
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Summary

In chronic vulvitis, chronic thrush represents the minority (about 20%) of all cases. Many patients tell us that their doctor prescribed anti-fungal medication without either examining them or taking a vaginal swab.

Multiple courses of anti-fungals should not be given without confirmation of candidiasis on vaginal culture. Particularly for patients with chronic vulvovaginal candidiasis, the length of time that the patient needs to be withdrawn from such agents before vaginal culture is positive again can be many weeks. We therefore strongly recommend that patients always have a vaginal swab before any treatment is commenced.

The complication is that in many cases of genuine candidiasis, swabs are negative, mostly due to anti-fungal use. In this scenario, history taking is key.

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The Vulva
A Practical Handbook for Clinicians
 , pp. 147 - 158
Publisher: Cambridge University Press
Print publication year: 2023

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