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C. glabrata Vulvovaginitis — SCE Infectious Diseases MCQ

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HardSTIsC. glabrata VulvovaginitisSCE Infectious Diseases

A 28-year-old woman presents with severe vulvovaginal itching, thick white 'cottage cheese' discharge, and vulval erythema. She has poorly controlled type 1 diabetes (HbA1c 82 mmol/mol). High vaginal swab grows Candida glabrata. She has previously failed Fluconazole 150 mg. What is the most appropriate treatment?

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Correct answer: A — Intravaginal Nystatin 100,000 units nightly for 14 days (or intravaginal Boric Acid 600 mg daily for 14 days)

Candida glabrata has intrinsic reduced susceptibility to azoles (including Fluconazole and topical azoles), explaining the treatment failure. For non-albicans Candida vulvovaginitis (particularly C. glabrata), intravaginal Nystatin (which is not azole-dependent) or intravaginal Boric Acid 600 mg daily for 14 days are effective alternatives. Optimising glycaemic control is also essential, as hyperglycaemia promotes Candida overgrowth. If systemic treatment is needed, Flucytosine intravaginally is another option.

Reference: BASHH 2019 – Vulvovaginal candidiasis; NICE CKS 2024 – Candida glabrata