Management of genital candidiasis

BMJ 1995;311:629 (2 September)

Letters

Management of genital candidiasis

Review omitted issues on recurrent thrush

EDITOR,--The British Society for Medical Mycology's review onthe management of genital candidiasis fails to bring out someimportant points.¹

Firstly, the vulval vestibulitis syndrome is not included inthe section on differential diagnosis. This, however, is thecommonest misdiagnosis in our clinic for patients with recurrentthrush and must be considered in any patient who complains ofsuperficial dyspareunia.²

Secondly, the authors suggest that "recommended regimens arenot clearly related to difference between drugs." Neither arethey clearly related to differences between patients. Unfortunately,almost all comparative treatment studies have been in unselectedwomen. In the section on management of recurrent disease theauthors mention that recurrence may be due to sequestrationof fungal hyphae and spores in the deeper layers of the vaginalepithelium, which then regrow when conditions are favourable.This "vaginal relapse" hypothesis implies that it may be possibleto . . . [Full text of this article]