Synopsis
Diagnose inflammatory Candida vulvovaginitis rather than treating a culture result, manage pregnancy safely, and investigate repeated symptoms before committing a patient to recurrent-disease suppression.
- VVC is an inflammatory syndrome: itch, soreness, burning, erythema, oedema or fissuring matters more than whether discharge looks curdy.
- No symptom or discharge appearance is diagnostic; inspect persistent or atypical disease and consider dermatitis, dermatosis, herpes, vulvodynia, trichomoniasis and cervical infection.
- Use microscopy to support symptomatic infection, and interpret culture with the examination because Candida growth without symptoms is colonisation.
Key red flags
Fever, lower abdominal pain, cervical excitation or adnexal tenderness is not explained by uncomplicated VVC and requires a pelvic-infection and emergency differential.
Collapse, shoulder-tip pain, bleeding or significant abdominal pain when pregnancy is possible requires urgent ectopic-pregnancy assessment.
Rapidly spreading erythema, tissue necrosis, marked oedema, ulceration or inability to pass urine demands examination for severe infection or another vulval process.
Postcoital, intermenstrual or postmenopausal bleeding needs cervical and cancer-focused assessment rather than attribution to thrush.
Severe or refractory inflammation with poorly controlled diabetes or major immunosuppression requires culture, species identification and specialist-directed management.
Investigation priorities
Link a current inflammatory episode to budding yeast or pseudohyphae before treatment obscures the finding.
Management branches
A stable adult has a first or occasional episode with a compatible inflammatory pattern.
- Ask about itch, soreness, external dysuria, odour, pelvic symptoms, bleeding, pregnancy possibility, recent antibiotics, diabetes risk and products already applied.
- Examine and obtain microscopy when symptoms are severe, atypical, persistent or diagnostically uncertain; do not let discharge colour substitute for syndrome recognition.