Recurrent VVC Suppressive Fluconazole — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

EasySTIsRecurrent VVC Suppressive FluconazoleSCE Infectious Diseases

A 35-year-old woman with HIV develops recurrent vulvovaginal candidiasis (6 episodes in 12 months). She is on effective ART (CD4 480, VL <50). She has tried intermittent Fluconazole treatment. What long-term strategy should be offered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Fluconazole 150 mg weekly suppressive therapy for 6 months, then trial discontinuation — this is the standard approach for recurrent VVC regardless of HIV status

Recurrent VVC (≥4 episodes per year) is managed with suppressive therapy: Fluconazole 150 mg once weekly for 6 months, then trial discontinuation. If recurrence resumes, extended suppression (up to 12 months) may be needed. During suppression, Candida susceptibility should be monitored (resistance can develop with prolonged azole exposure). Modifiable risk factors (diabetes, antibiotic use, oestrogen exposure) should be addressed. This approach applies equally to HIV-positive and HIV-negative women. Boric acid intravaginal capsules are an adjunct for azole-resistant non-albicans Candida.

Reference: BASHH 2019 – VVC; NICE CKS 2024