Two articles on vulvovaginal disorders1,2 (O&G Magazine Vol 16 No 3 Spring 2014) describe some empirical treatment and suggest non-albicans yeasts need treatment when there is locally researched evidence to the contrary.3

An example of the potential for error managing vaginal yeast infection was a 32-year-old I saw this week with vulval psoriasis whose GP had made her condition considerably worse by prescribing boric acid pessaries for a non-albicans yeast found on culture. There is a relative lack of strategies in the articles for management of the particularly important condition of recurrent vaginal candidiasis. I am referring to overlooked treatments including depot medroxyprogesterone acetate (DMPA), my preferred treatment for the woman requiring contraception.4

When discussing vulval pain, it should not be forgotten that this is an eminently preventable condition, providing one avoids empirical treatment and attends to the inevitable sexual complications present in many of these women. Avoidance of empirical treatment means that the clinician needs to use a microscope and/or liaise with a pathology service when managing almost every patient with these complaints.

Author’s response

Dr Bradford, A/Prof Fischer and Dr Dennerstein make very good points in their discussions around aspects of chronic vaginal discharge diagnosis and management. The first letter introduced some additional causes for non-infective chronic vaginal discharge, and also emphasised the importance of differentiating normal, as opposed to abnormal vaginal discharge. It is very pleasing that these learning points have been highlighted, they should certainly be considered in clinical practice. The second letter provides a useful clinical example highlighting the need to consider other treatments for recurrent vaginal candidiasis. This constructive feedback is very beneficial for directing further research on the topic and for providing a more complete picture on diagnosis and management.

Dr Patricia Car MBBS, DRANZCOG