Management of Vulvovaginal Candidiasis in Pregnancy

Abstract

Objective: This study aimed at describing VVC therapy that has been proven to be safe in pregnancy. Background: Pregnancy is a risk factor for vulvovaginal candidiasis (VVC). The most common cause of VVC in pregnancy is Candida albicans. When symptoms and signs of vulvar pruritus, pain, swelling, redness, burning sensation, dyspareunia, dysuria, vulvar edema, fi ssures, excoriation and vaginal discharge are found which suggest VVC, it is necessary to perform microscopic examination and/or fungal culture to establish the diagnosis of VVC. In pregnancy, VVC must be treated as soon as possible because it can cause adverse perinatal outcomes such as premature labor, premature rupture of membranes, low birth weight babies and fetal brain problems. Unfortunately, prescription oral antifungal therapy in pregnancy is still found. Treatment with oral antifungal is not recommended because of the risk of causing congenital abnormalities in the fetus. Methods: Literatures in English and Indonesian were searched with topic restrictions on the type of publication for the last thirty years. Summary: Topical intravaginal antifungal therapy such as clotrimazole and nystatin, are the recommended treatment for VVC in pregnancy that has been shown its safety. In addition, giving prophylaxis in the last trimester of pregnancy in asymptomatic VVC cases provides good pregnancy and neonatal outcomes but is still debated. In severe, prolonged or recurrent cases of VVC, other co-infections may be sought which may also need to be managed. Administration of probiotics for VVC therapy still requires further research.