Overview
Candidiasis of the urogenital tract involves infection of the urinary bladder, urethra, vulva, vagina, or penis by Candida species, most commonly Candida albicans. It presents with symptoms such as dysuria, vulvar itching, vaginal discharge, and in males, urethritis or balanitis 1.Diagnosis
Clinical symptoms including dysuria, itching, and abnormal discharge
Microbiological confirmation via microscopy and culture of urogenital specimens 1
Histopathological examination may be necessary in complex or recurrent cases 1Management
First-line treatment:
- Oral fluconazole: 50-100 mg daily for 7-14 days 1
- Topical azoles: such as clotrimazole, miconazole, or nystatin for localized infections 1
Adjunctive treatments:
- Intravaginal therapy: for recurrent vulvovaginal candidiasis 1
- Antifungal suppositories: for male urethritis or balanitis 1Special Populations
Pregnancy: Use of topical azoles is generally preferred over systemic fluconazole due to potential risks to the fetus 1
Pediatrics: Treatment often involves topical antifungals; systemic therapy may be considered based on severity and response 1
Elderly: Increased susceptibility to complications; careful monitoring and adherence to treatment are crucial 1
Comorbidities: Patients with diabetes or immunosuppression may require longer treatment durations and closer follow-up 1Key Recommendations
Confirm diagnosis with microbiological testing including culture and microscopy 1
Initiate treatment with oral fluconazole for systemic involvement or severe cases (Evidence: Strong) 1
Use topical azoles for mild to moderate localized candidiasis (Evidence: Strong) 1
Consider patient-specific factors such as pregnancy status when selecting antifungal therapy (Evidence: Moderate) 1
Monitor and manage recurrent infections with prolonged or suppressive therapy as needed (Evidence: Expert opinion) 1References
1 Vo LT, Armany D, Bariol SV, Baskaranathan S, Hossack T, Ende D et al.. Financial barriers in urology publishing: an analysis of legitimate and predatory journals. ANZ journal of surgery 2025. link