What is the safest/most appropriate treatment for vaginal candidiasis during pregnancy?
—Nancy Tosone, MSN, APRN, Omaha, Neb.

Vulvovaginal candidiasis is common during pregnancy and does not require treatment unless symptomatic. Vulvovaginal pruritus and soreness are the most common symptoms. The CDC recommends once-daily intravaginal application of imidazoles. There have been no reported cases of fetal abnormalities with such treatment, which should be continued for at least seven days. In addition, advise patients to use caution when inserting the applicator to avoid injuring the cervix. Additional imidazole cream may be applied if vulvar symptoms are present. Oral antifungals should not be used. There is evidence that topical imidazoles, such as clotrimazole, miconazole, and econazole, are more effective than topical nystatin. Diabetes should be considered if vaginal candidiasis is recurrent or complicated. Finally, a urine glucose test is warranted. For further discussion, see Cochrane Database Syst Rev. 2001;(4):CD000225.
—Virginia Joslin, PA-C, MPH (120-16)