Vaginal candidiasis manifests with distinct clinical features (Lippincott Review of Pathology):

• Itching and irritation: Intense vulvovaginal pruritus (itching) is the hallmark symptom.
• Abnormal discharge: Thick, white, "cottage cheese-like" discharge, often odorless.
• Erythema and swelling: Redness and inflammation of the vulva and vaginal mucosa.
• Dysuria and dyspareunia: Pain during urination or intercourse due to mucosal irritation.
• Burning sensation: Particularly during urination.

Complicated cases (e.g., recurrent or severe infections) may involve extensive redness, fissures, or edema (Mayo Clinic). Immunocompromised individuals, such as those with uncontrolled diabetes or HIV, are at higher risk for severe presentations (WHO).

The pathogenesis of vaginal candidiasis involves disruption of the vaginal microbiome, allowing Candida overgrowth. Key contributors include:

1. Antibiotic use: Broad-spectrum antibiotics reduce protective lactobacilli, increasing yeast proliferation (Lange Textbook of Clinical Pharmacology).
2. Hormonal changes: Elevated estrogen levels during pregnancy, hormone therapy, or oral contraceptive use promote glycogen production, a nutrient source for Candida (BNF).
3. Immunosuppression: Diabetes mellitus, corticosteroid use, or HIV impair immune responses (WHO).
4. Lifestyle factors: Tight-fitting clothing, poor hygiene, or douching disrupt the vaginal environment (Mayo Clinic).
5. Genetic predisposition: Some women exhibit recurrent infections due to host susceptibility (Lippincott Textbook of Pharmacology).

Preventing recurrence focuses on minimizing risk factors and maintaining vaginal health:

• Avoid irritants: Steer clear of scented hygiene products, douches, and synthetic underwear.
• Probiotics: Lactobacillus-rich supplements or yogurt may restore vaginal flora (Comprehensive Pharmacy Review).
• Glycemic control: For diabetic patients, maintaining blood sugar levels reduces infection risk (WHO).
• Breathable clothing: Cotton underwear and loose-fitting garments reduce moisture buildup.
• Judicious antibiotic use: Limit unnecessary antibiotics and consider prophylactic antifungals if prone to infections (BNF).

Treatment depends on infection severity and recurrence:

1. First-line Therapy

• Topical antifungals: Clotrimazole (1% cream, 100mg vaginal tablet) or nystatin pessaries for 1–7 days (BNF).
• Oral agents: Single-dose fluconazole (150mg) is effective for uncomplicated cases (Lange Textbook of Clinical Pharmacology).

2. Recurrent Infections (≥4 episodes/year)

• Extended regimens: Fluconazole 150mg weekly for 6 months or topical therapy for 10–14 days (Mayo Clinic).
• Maintenance therapy: Monthly fluconazole may prevent relapse (Lippincott Textbook of Pharmacology).

3. Non-pharmacological Approaches

• Boric acid suppositories: Used for azole-resistant Candida glabrata infections (Comprehensive Pharmacy Review).
• Probiotic supplementation: Adjunct therapy to restore microbial balance (WHO).

Note: Always rule out other causes (e.g., bacterial vaginosis, STIs) before treatment.

Consult a healthcare provider if:

• Symptoms persist despite treatment.
• Infections recur frequently (>3–4 times/year).
• Severe pain, fever, or systemic symptoms occur (indicating possible invasive candidiasis) (Lippincott Review of Pathology).

Vaginal candidiasis is a manageable condition with timely diagnosis and appropriate therapy. Preventive measures, such as maintaining vaginal pH balance and avoiding triggers, are critical for reducing recurrence. Pharmacological interventions, guided by resources like the BNF and Mayo Clinic, remain highly effective. Patients with persistent symptoms should seek evaluation to exclude underlying conditions or resistant strains.

• British National Formulary (BNF)
• Lippincott Review of Pathology
• Mayo Clinic
• World Health Organization (WHO)
• Lange Textbook of Clinical Pharmacology
• Comprehensive Pharmacy Review
• Lippincott Textbook of Pharmacology

By integrating evidence-based strategies, healthcare providers and patients can collaboratively address this common yet disruptive condition.