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Vulvovaginal Candidiasis as a Chronic Disease: Diagnostic Criteria and Definition

Hong, Esther BSc, MBBS1; Dixit, Shreya B Med Sci, MBBS(Hons)2; Fidel, Paul L. PhD3; Bradford, Jennifer MBBS, FRANZCOG4; Fischer, Gayle MBBS(Hons), FACD1

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 31–38
doi: 10.1097/LGT.0b013e318287aced
Original Articles

Objective Although recurrent vulvovaginal candidiasis is defined as 4 or more discrete attacks of vulvovaginal candidiasis per year, there is no diagnostic nomenclature or definition for the many women who are chronically symptomatic. This study aims to establish and propose a definition and a set of diagnostic criteria, which would enable clinicians to promptly identify and treat women with chronic vulvovaginal candidiasis (CVVC).

Design Prospective cohort study.

Setting Public and private vulvar dermatology outpatient clinics in Sydney, Australia.

Participants Data were obtained prospectively from 50 women with presumptive CVVC and 42 controls. Historical and clinical features of CVVC identified by expert consensus were compared between the 2 groups. Diagnostic criteria were then prospectively applied to a further 163 patients to verify their accuracy.

Outcome Measures Signs and symptoms diagnostic of CVVC.

Results The following characteristics were found to be significantly more common in women with CVVC compared to controls (p ≤ .001): a history of positive vaginal Candida swab, discharge, dyspareunia, soreness, swelling, cyclicity, and exacerbation of symptoms with antibiotics.

Conclusions We propose that CVVC can be confidently diagnosed using the major criteria of a chronic nonspecific and nonerosive vulvovaginitis that includes at least 5 or more properties from the following criteria: soreness, dyspareunia, positive vaginal swab either at presentation or in the past, previous response to antifungal medication, exacerbation with antibiotics, cyclicity, swelling, and discharge. This condition responds reliably to oral antifungal medication.

1Northern Clinical School, University of Sydney; 2Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia; 3Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA; and 4University of Western Sydney, NSW, Australia

Reprint requests to: Shreya Dixit, B Med Sci, MBBS(Hons), Department of Dermatology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia. E-mail:

The authors have declared they have no conflicts of interest.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology