Recurrent vulvovaginal candidiasis

### What you need to know A 22 year old woman asks your advice for treating recurrent thrush. She has self managed with over-the-counter treatments eight times in the past six months. She is frustrated and wants to know why it keeps coming back. Recurrent vulvovaginal candidiasis (RVVC) is a common problem, with an estimated prevalence of 9% in women aged 25-34 years.1 In this article we offer an approach to a safe and effective assessment of a woman presenting in primary care with symptoms of RVVC. We highlight key points from the recently updated British Association of Sexual Health and HIV (BASHH) guideline2 combined with tips from our clinical experience as general practitioners with a special interest in women's health. ### What are the symptoms of recurrent vulvovaginal candidiasis? Typical symptoms of RVVC are vulval itching and a non-offensive vaginal discharge. Other common symptoms include soreness, superficial dyspareunia, and a cyclical pattern of symptoms.2 Although a curd-like discharge is typical, discharge can be thin or absent altogether. A green or yellow discharge, or one with an offensive odour, may indicate other causes of infection. ### What else should you cover in the history? Ask if the patient has a history of skin problems such as psoriasis or eczema. Does she have poorly controlled diabetes or symptoms of undiagnosed diabetes? Does she have any medical conditions or take any medications that might cause immunosuppression? Patients are often keen to explore any underlying causes or contributing factors, to help avoid further recurrences. These are listed in box 1. Box 1 ### Causes and triggers for recurrent vulvovaginal candidiasis (RVVC)RETURN TO TEXT