GPAtlas🧭 When to suspect
Vulvovaginal candidiasis (VVC, ‘thrush’) is symptomatic inflammation of the vulva and/or vagina caused by overgrowth of Candida – Candida albicans in 80–89% of cases, with non-albicans species (notably C. glabrata and C. krusei) making up the rest. Suspect it when vulval itch is the predominant symptom, classically with a thick, white, curdy (‘cottage cheese’) discharge that is non-offensive. Around 75% of women have at least one lifetime episode.
Two points shape good practice. First, VVC is a clinical diagnosis: empirical treatment is reasonable for a first or isolated episode, but the symptoms and signs are not specific, and over half of women who self-diagnose recurrent ‘thrush’ actually have another condition. Second, up to 20% of women are asymptomatic carriers of Candida and do not require treatment – treat the woman, not the swab.
| Pattern | Definition | What it means |
|---|---|---|
| Acute VVC | First or isolated symptomatic episode, with Candida on microscopy and/or culture | A single dose of antifungal usually suffices |
| Recurrent VVC | ≥ 4 symptomatic episodes in 12 months, with at least 2 confirmed by microscopy or culture (at least one a positive culture) | Confirm, examine, investigate, then induction + 6-month maintenance |
Raise suspicion further with recent antibiotics (within ~3 months), pregnancy, poorly controlled diabetes, immunosuppression, and high-oestrogen states (pregnancy, HRT, possibly the combined pill). Note that BASHH now uses the terms ‘acute’ and ‘recurrent’ rather than the older ‘uncomplicated/complicated’.
Source: BASHH National Guideline 2019
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