Candida vulvovaginitis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

The diagnosis of Candida vulvovaginitis is based on the clinical findings, supported by laboratory findings. Laboratory studies done for diagnosis include measurement of the vaginal pH, visualization of hyphae on wet mount/ microscopy, as well as culture.

Laboratory Findings

The laboratory findings consistent with the diagnosis of Candida vulvovaginitis include:

• Vaginal pH: vaginal pH is normal (ranges from 4.0-4.5)
• Wet mount or Saline preparation: It will help in detection of hyphae, clue cells and motile trichomonas differentiating different causes of vaginitis.
• 10% Potassium hydroxide preparation: It is more sensitive than wet mount to demonstrate budding blastospores or pseudohyphae.
• Culture: Culture for diagnosing candida vulvovaginitis not recommended in patients with positive microscopy. However, it should be done in a symptomatic woman with a negative microscopy and a normal vaginal pH. Culture using Sabouraud agar, Nickerson’s medium, or Microstix-Candida medium identify candida species with equal sensitivity.

Approach to patient with Candida Vulvovaginitis

The following is a algorithm for diagnosis and treatment of vulvovaginal candidiasis :

Symptomatic Vaginitis

Whitish discharge adherent to the vaginal walls, excoriations and fissures in the genital area

Perform direct microscopy of the vaginal discharge with saline or 10% KOH Estimate pH of vaginal discharge

Negative direct microscopy pH < 4.5

Positive direct microscopy

Send for culture Consider azole therapy

No culture necessary

pH < 4.5 No excess WBC's

pH > 4.5 Excess WBC's

Start azole therapy

Consider mixed infection

Algorithm adopted from Vulvovaginal candidiasis Lancet 2007; 369: 1961–71

Gallery

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  Wet mounted vaginal smear specimen, revealed the presence of Candida albicans, which had been extracted from a patient with vaginal candidiasis. From Public Health Image Library (PHIL).