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Candidal Vaginitis

by David E. Soper, MD

Candidal vaginitis is vaginal infection with Candida sp, usually C. albicans.

Most fungal vaginitis is caused by C. albicans (see also Candidiasis (Mucocutaneous)), which colonizes 15 to 20% of nonpregnant and 20 to 40% of pregnant women.

Risk factors for candidal vaginitis include the following:

  • Diabetes

  • Use of a broad-spectrum antibiotic or corticosteroids

  • Pregnancy

  • Constrictive nonporous undergarments

  • Immunocompromise

  • Use of an intrauterine device

Candidal vaginitis is uncommon among postmenopausal women except among those taking systemic hormone therapy.

Symptoms and Signs

Vaginal vulvar pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common, as is a thick, white, cottage cheese–like vaginal discharge that adheres to the vaginal walls. Symptoms and signs increase the week before menses. Erythema, edema, and excoriation are common.

Infection in male sex partners is rare.

Recurrences after treatment are uncommon.


  • Vaginal pH and wet mount

Vaginal pH is < 4.5; budding yeast, pseudohyphae, or mycelia are visible on a wet mount, especially with KOH. If symptoms suggest candidal vaginitis but signs (including vulvar irritation) are absent and microscopy does not detect fungal elements, fungal culture is done. Women with frequent recurrences require culture to confirm the diagnosis and to rule out non-albicans Candida.


  • Antifungal drugs (oral fluconazole in a single dose preferred)

  • Avoidance of excess moisture accumulation

(See also the Centers for Disease Control and Prevention practice guideline Sexually transmitted diseases characterized by vaginal discharge .)

Keeping the vulva clean and wearing loose, absorbent cotton clothing that allows air to circulate can reduce vulvar moisture and fungal growth.

Topical or oral drugs are highly effective (see Table: Drugs for Candidal Vaginitis). Adherence to treatment is better when a one-dose oral regimen of fluconazole 150 mg is used. Topical butoconazole, clotrimazole, miconazole, and tioconazole are available OTC. However, patients should be warned that topical creams and ointments containing mineral oil or vegetable oil weaken latex-based condoms. If symptoms persist or worsen during topical therapy, hypersensitivity to topical antifungals should be considered.

Drugs for Candidal Vaginitis



Topical or vaginal


Sustained-release preparation of 2% cream

5 g as a single application


1% cream 5 g once/day for 7 to 14 days or 2% cream 5 g for 3 days


2% cream 5 g once/day for 7 days or 4% cream 5 g for 3 days

Vaginal suppository 100 mg once/day for 7 days or 200 mg once/day for 3 days or 1200 mg, only once


0.4% cream 5 g once/day for 7 days or 0.8% cream 5 g once/day for 3 days

Vaginal suppository 80 mg once/day for 3 days


6.5% ointment 5 g once



150 mg in a single dose

Frequent recurrences require long-term suppression with oral drugs (fluconazole 150 mg weekly to monthly or ketoconazole 100 mg once/day for 6 mo). Suppression is effective only while the drugs are being taken. These drugs may be contraindicated in patients with liver disorders. Patients taking ketoconazole should be monitored periodically with liver function tests.

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