What are the indications for referring a patient with recurrent candidiasis to a specialist?

Indications for referring a patient with recurrent candidiasis to a specialist include:

• Recurrent episodes of oral candidiasis, especially if infection persists despite treatment or recurs frequently, warrant referral to an oral surgeon or specialist for further assessment ¹.
• Breakthrough candidal infection occurring while the patient is on preventive antifungal treatment, which may indicate antifungal resistance, is an indication for specialist referral ¹.
• Diagnostic uncertainty about the cause of candidiasis, where the diagnosis is doubtful, should prompt referral for specialist evaluation ¹,².
• Chronic plaque-like oral candidiasis that is unresponsive to treatment requires referral for biopsy due to the risk of malignancy ¹.
• Failure to respond to at least 2 weeks of appropriate antifungal treatment is a criterion for referral for further investigation ¹.
• In female genital candidiasis, referral or specialist advice is recommended if non-albicans Candida species are identified, as these may respond poorly to standard treatments and may require alternative management ².
• Patients with recurrent candidiasis and underlying conditions such as uncontrolled diabetes should be considered for specialist referral to optimize management of both candidiasis and the underlying condition ².

Clinical judgement should be used considering severity, immunocompromise, and treatment response, with a low threshold for early referral in severe or complicated cases ¹.