Vulvovaginal candidiasis

Definition

• Vulvovaginal candidiasis is inflammation of the vulva and vagina due to infection with Candida species, most commonly Candida albicans.
• Because Candida also colonises many healthy women (about 15–20 % of non-pregnant and 20–40 % of pregnant women), the diagnosis requires both corresponding symptoms and laboratory detection of the organism.

Classification

Special Cases

• Before the due date: reduces oral thrush/nappy rash rate in the newborn.
• With four or more episodes per year: recurrent candidiasis.

• Recurrent disease is defined as at least 3–4 documented episodes within 12 months.

Occurrence & epidemiology

Epidemiology

• Up to 75 % of women have at least one lifetime episode and 5–10 % develop recurrent disease; it causes around one third of all cases of vulvovaginitis.
• Candida albicans is the most common pathogen; among non-albicans species, Candida glabrata is the most relevant and is becoming more frequent.

Aetiopathogenesis

Factors Favouring Infection

• Other factors: diabetes, immunosuppression, pregnancy.
• In severe obesity, what is characteristic is: intertriginous spread into inguinal folds.

Aetiology and risk factors

• Risk factors include pregnancy with raised oestrogen levels, diabetes mellitus, immunosuppression, systemic broad-spectrum antibacterial agents and synthetic underwear; after the menopause the condition is uncommon without systemic oestrogen.

Clinical features

Clinical Presentation and Findings

• Main symptoms: itching, burning, reddened vulva.
• Discharge: whitish, crumbly, odourless.
• The pH is: characteristically normal, i.e., below 4.5.
• On a wet mount, one sees: pseudohyphae, budding yeasts.
• Most common pathogen: Candida albicans.

• Typical symptoms are vulvovaginal itching, burning and irritation, as well as dysuria and dyspareunia; symptoms often increase in the week before menstruation.
• Findings include redness, swelling and excoriation of the vulva and vagina, sometimes fissures, with thick, white, curd-like, adherent discharge, which may however be scant or absent.

Diagnosis

Typical imaging findings

• Clinical finding: On speculum examination thick, white, curd-like plaques lie on the reddened vaginal wall. They can be wiped off, leaving a slightly bleeding surface; the discharge itself is odourless and the pH remains acidic.

• Vaginal pH is typically below 4.5.
• On wet mount, especially with 10 % potassium hydroxide, budding yeast, pseudohyphae or mycelia are seen; potassium hydroxide raises sensitivity from 30–40 % to 60–80 %.
• Fungal culture is used mainly in persistent or recurrent symptoms to confirm the diagnosis and detect non-albicans species; molecular tests are an option when microscopy is inconclusive.

Keep learning in the app

Further reading (selection)

1. MSD Manual Professional: Candidal Vaginitis
2. A Comprehensive Overview of Candida albicans as the Leading Pathogen in Vulvovaginal Candidiasis (J Fungi (Basel) 2025, PubMed Central)
3. StatPearls: Vaginal Candidiasis (NCBI Bookshelf)
4. DocCheck Flexikon, Soorkolpitis

Cross-references