Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Recurrent Vulvovaginal Candidiasis
     
     RVVC, usually defined as three or more episodes of symptomatic
VVC annually, affects a small proportion of women (probably less
than 5%). The natural history and pathogenesis of RVVC are poorly
understood. Risk factors for RVVC include diabetes mellitus,
immunosuppression, broad spectrum antibiotic use, corticosteroid
use, and HIV infection, although the majority of women with RVVC
have no apparent predisposing conditions. Clinical trials
addressing the management of RVVC have involved continuing therapy
between episodes.

Treatment
     The optimal treatment for RVVC has not been established.
Ketoconazole 100 mg orally, once daily for up to 6 months reduces
the frequency of episodes of RVVC. Current studies are evaluating
weekly intravaginal administration of clotrimazole, as well as oral
therapy with itraconazole and fluconazole, in the treatment of
RVVC. All cases of RVVC should be confirmed by culture before
maintenance therapy is initiated.

     Although patients with RVVC should be evaluated for
predisposing conditions, routinely performing HIV testing for women
with RVVC who do not have HIV risk factors is unwarranted.

Follow-Up
     Patients who are receiving treatment for RVVC should receive
regular follow-up to monitor the effectiveness of therapy and the
occurrence of side effects.

Management of Sex Partners
     Treatment of sex partners does not prevent recurrences, and
routine therapy is not warranted. However, partners with
symptomatic balanitis or penile dermatitis should be treated with
a topical agent.

Special Considerations

HIV Infection -
     Insufficient information exists to determine the optimal
management of RVVC among HIV-infected women. Until such information
becomes available, management should be the same as for other women
with RVVC.

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