Australasian Chapter of Sexual Health Medicine
Recommendations from the Australasian Chapter of Sexual Health Medicine on herpes, chlamydia, candidiasis, ureaplasma & gonorrhoea. The Australasian Chapter of Sexual Health Medicine (AChSHM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Sexual Health Medicine Fellows and trainees in Australia and New Zealand.
3.
Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.
While topical and oral anti-fungal agents are the recommended treatment for candidiasis, an adequate clinical and microbiological assessment should be undertaken before they are prescribed or self-administered by patients for recurrent or persistent symptoms of vulvovaginal candidiasis. It is important to rule out other causes of vulvovaginal symptoms such as bacterial vaginosis or genital herpes first so that the other infections are not left untreated. Moreover, inappropriate use of antifungal drugs can lead to increased fungal resistance, especially in non-albicans species of candida.
This recommendation is endorsed by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
Supporting evidence
- Davies S, Johnson E, White D. How to treat persistent vaginal yeast infection due to species other than Candida albicans. Sexually Transmitted Infections 2013; 89: 165–166.
- Dun E. Antifungal resistance in yeast vaginitis. Yale Journal of Biology & Medicine 1999; 72(4): 281–285.
- Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369: 1961–71.
How this list was made
With the assistance of the Royal Australasian College of Physicians as part of Evolve, the Australasian Chapter of Sexual Health Medicine (AChSHM) Council produced and distributed to its membership an online survey. The survey listed 5 examples of clinical practices in sexual health medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context.
Members were asked to comment on these examples and to suggest other low-value practices which may be a sizeable issue in the specialty. Based on the feedback, 8 items were identified for further investigation by AChSHM Council through an evidence review. This resulted in the final list of 5 recommendations which were endorsed by the Council on 15 December 2016.
In July 2018 the Australasian Chapter of Sexual Health Medicine undertook a review of their Top-5 recommendations. Due to changes in evidence, and physician support, recommendation 5 was replaced. The removed recommendation read: “Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence (i.e. <1% prevalence) populations and people who do not belong to a higher risk group.”
- 1 Do not order herpes serology tests unless there is a clear clinical indication.
- 2 Do not screen for chlamydia using serological tests.
- 3 Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.
- 4 Do not test for ureaplasma species in asymptomatic patients.
- 5 Do not prescribe testosterone therapy to older men except in confirmed cases of hypogonadism