How can I differentiate between vulvovaginal candidiasis and other causes of vulvovaginal symptoms?

Differentiating vulvovaginal candidiasis (VVC) from other causes of vulvovaginal symptoms involves careful clinical assessment and appropriate investigations. VVC typically presents with intense vulval itching, soreness, and a thick, white, curd-like vaginal discharge without a strong odour, whereas other causes such as bacterial vaginosis or trichomoniasis often have a malodorous discharge and different symptom profiles ¹.

On examination, vulval erythema and swelling may be present in VVC, but the absence of these signs does not exclude infection ¹. Other causes of vulvovaginal symptoms, including noncandidal vaginitis, may present with different discharge characteristics, odour, and less intense pruritus (Neal et al., 2020).

Microscopic examination of vaginal secretions and high vaginal swabs (HVS) for culture and sensitivity are essential to confirm Candida species and to exclude other infections or mixed causes ¹. This is particularly important in recurrent or treatment-resistant cases, or when symptoms persist despite antifungal therapy ¹.

In contrast, bacterial vaginosis is diagnosed by the presence of clue cells on microscopy and a characteristic fishy odour, while trichomoniasis shows motile trichomonads on wet mount (Neal et al., 2020).

It is also important to consider underlying conditions such as diabetes mellitus or immunocompromise, which predispose to VVC and may complicate diagnosis and management ¹.

Other vulvovaginal conditions such as vulval eczema, lichen sclerosus, or vulval malignancy can mimic candidiasis symptoms but usually have distinct clinical features such as chronicity, skin changes, or ulceration, and require specialist referral if suspected ¹,².

In summary, differentiation relies on symptom pattern, clinical examination, and targeted investigations including microscopy and culture, with consideration of patient history and risk factors to guide diagnosis and management ¹[(Sobel, 1992); (Neal et al., 2020)].