Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Indications for referring a patient with recurrent candidiasis to a specialist include:
- Recurrent episodes of oral candidiasis, especially if infection persists despite treatment or recurs frequently, warrant referral to an oral surgeon or specialist for further assessment NICE CKS.
- Breakthrough candidal infection occurring while the patient is on preventive antifungal treatment, which may indicate antifungal resistance, is an indication for specialist referral NICE CKS.
- Diagnostic uncertainty about the cause of candidiasis, where the diagnosis is doubtful, should prompt referral for specialist evaluation NICE CKS,NICE CKS.
- Chronic plaque-like oral candidiasis that is unresponsive to treatment requires referral for biopsy due to the risk of malignancy NICE CKS.
- Failure to respond to at least 2 weeks of appropriate antifungal treatment is a criterion for referral for further investigation NICE CKS.
- In female genital candidiasis, referral or specialist advice is recommended if non-albicans Candida species are identified, as these may respond poorly to standard treatments and may require alternative management NICE CKS.
- Patients with recurrent candidiasis and underlying conditions such as uncontrolled diabetes should be considered for specialist referral to optimize management of both candidiasis and the underlying condition NICE CKS.
Clinical judgement should be used considering severity, immunocompromise, and treatment response, with a low threshold for early referral in severe or complicated cases NICE CKS.