Candidíase recurrente 💡
At least 3 symptomatic episodes within the previous year DDx: lichen simplex chronicus, psoriasis, lichen planes, Vulvar impetigo, neuropathic vaginal itch, lichen sclerosis, candidiasis, systemic diseases (HIV, hepatic, kidney disease) Principal: candida is a gut comensal, is symbiotic in vaginal flora, as symptomatic. Can overgrow due to hormonal factors (some women have catamenial flares) Factors Host factors: diabetes, obesity, imunossupression Iatrogenic: hormonal treatments, corticosteroids, antibiotics, immunosuppressants Behavior factors: sponge/IUD, intercourse (frequency/enthusiasm), orogenital factors Approach Do a propper diagnosis Swab and wet prep Microscopy Antifungal sensitivity Exclude Other DDx: STI, vulvar dermatoses Host factors Diabetes Pregnancy (topical therapy only!) Steroidal therapy Undiagnosed HIV Chemotherapy and Transplant Hormonal factors: catamenial or luteal phase flare. contraception Behavior factors sponge/IUD intercourse (frequency/enthusiasm) orogenital sex Treatment Detroit regime (Sobel et al 2004) most popular UK BASHH US CDC Belgium guidelines If catamenial flares: hormonal suppression treatment, or fluconazol 2-3 days before catamenial Fluconazol 150 D0, D3, D6 Nistatin 14 days Change contraception Boric acid 600mg OD x14d Amphotericin B 50mg od 14d Flucytosine 5g cream OD 14 d Dietary modification has no evidence that it works Probiotics have very low evidence Oteseconazole - new long acting trazole approved by CDC, but low efficacy and not available in europe Ibrexafungerp - new triterpenoid Suggestion Start with eradication (Detroit) If episodes are premenstual or catamenial chose fluconazole 2 days before cyclical symptom onset Fluconazol 150mg stat or 150mg x2 4-5 days apart Or hormonal solution for a hormonal problem cycle suppression with depo MPA, transdermal estriol + IUD If the symptoms are not cyclical think wrong diagnosis If it is cyclical think hormones
Made with Bullet