Condition management

Up to 20% of women of reproductive age may be colonized with asymptomatic Candida species. Asymptomatic Candida is more common (30-40%) and symptomatic is more prevalent throughout pregnancy, particularly during the third trimester.

There no evidence that thrush can harm the foetus, cause low birth weight or premature delivery.

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.

Guidelines

CKS Candida – female genital provides comprehensive information about managing vulvovaginal candidiasis in pregnancy

You should check if there is local guidance for you to use in your area.

Stepwise recommendations

The CKS guidelines recommend a stepwise approach starting with self-management measures if appropriate or possible, through the range of pharmacological options:

Non-pharmacological management

• Loose clothing and simple emollients as soap substitutes in the vulval area.
• Avoid perfumed products, vaginal douching and applying complimentary therapies e.g. yoghurt, probiotics, and tea tree oil.

Pharmacological management

Advise on antifungal drug treatment options for symptomatic acute infection depending on the woman’s age, co-morbidities, personal preference, and drug cautions and contraindications

First line

Clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights first-line (if aged 16 years and older).

Other options

If this treatment is not tolerated or is contraindicated, see the section on alternative treatment regimens.

If there are vulval symptoms, consider a topical imidazole in addition to an intravaginal antifungal such as clotrimazole 1% or 2% cream applied 2–3 times a day.

Advise follow-up if symptoms have not resolved within 7–14 days for acute infection.

Pregnancy outcome information

UKTIS provides information on pregnancy outcomes for clotrimazole and fluconazole in pregnancy.

Patient information

The UKTIS summary has corresponding BUMPS patient information.

The Royal College of Obstetrics and Gynaecology (RCOG) has patient information on skin conditions of the vulva

NHS Medicines A-Z provides a summary statement on the use of clotrimazole and fluconazole. The NHS also has information on thrush in pregnancy.