Candida is as real, and overlooked, and under treated, and misunderstood, and maligned as Lyme disease.  I recall when I started to practice in CT, and ran head-on into the epidemic of Lyme [54% of families in Wilton!]  I was getting info from the local docs, and I asked one of the prominent Lyme specialists what he did about Candida.  He responded that he never saw it!  Over the next few years, I saw several of his patients, and two had vaginitis as a major complaint, for which he had prescribed the standard OTC creams - but he never saw it as a systemic problem back then, although I think he does now. We were taught in Med school that systemic candida was a fatal complication of immune suppression, as with cancer and chemotherapy, and eventually AIDS.  Otherwise, it was a "normal" intestinal flora.  Just as the IDSA hasn't budged on Lyme, they haven't learned that the human relationship with candida has changed drastically since the advent of the high sugar diet, the antibiotics, the Birth control pills and the steroids, which together have created a monster.  Orion Truss, MD wrote a great little book in 1976: The Missing Diagnosis in which he correctly identified the colon as the source of the overg"owth, and with Nystatin and probiotics and a low carb, low yeast diet he could clear not only the GI problems, but also the vaginitis and a host of other symptoms such as fatigue, rashes, migraines and other chronic headaches, myalgia, arthralgia etc, etc.  However, it didn't take long to discover that the worst cases had negative stool cultures and negative antibodies, so many doctors discarded the baby with the bath water.  I believe that the negative cultures come about afzr the colony of yeast reaches a critical mass and develops a consciousness for self preservation [Read a new book - The Biology of Belief by Bruce Lipton, PhD - a cell biologist who supports that notion scientifically] and it sends "roots" into the gut wall [similar to "Thrush" in infants]to anchor itself against the eventuality of a purge that would leave the colony "out in the cold." That provides a more reliable source of nutrition, and the colony gradually becomes converted into an "underground" system of fungal filaments with negative cultures of stool.  The negative antibodies are characteristic of immune suppression, just as in Lyme.  That is a "systemic" non-fatal candida infection.  Dark field microscopy - now outlawed by CLIA - frequently showed mycelial forms in the blood which cleared when the absorbable antifungal drugs were used, but not Nystatin, which "can't get to the roots" like a lawnmower removing the dandelions temporarily.  [It is still very useful to prevent overgrowth, or as therapy in early cases, and is very safe because it is not absorbed. I believe it should be ROUTINELY prescribed with any antibiotic therapy, and especially in pregnancy]  How to diagnose?  Rectal brushings can be stained for the fungal elements.  [In a study that I reported in 1985, 55% of patients that I had clinically diagnosed as having candida were found to have parasites on the same specimens!]  That was in NYC [I am not finding it that high in Phoenix.]  In patients who do make antibodies, the presence of antigen/antibody complexes is diagnostic of invasion.  Some patients even have (+) PCR.  [I don't know why others do not, but absence of evidence is not evidence of absence.]  The reaction to candida antigen by skin test is both diagnostic and useful therapeutically.  In the Environmental Allergy approach, the quantitative skin testing by serial endpoint titration enables us to specifically treat the enormous allergy that most of these patients develop and characteristically leads to spreading allergies to foods and chemicals.  One of the big breakthroughs in indirect diagnosis is by finding yeast metabolites in the urine - Tartaric Acid and Arabinose are pathognomonic.  [Dr William Shaw at Great Plains Labs discovered this while doing his Organic Acid test.  Other dysbiotic organisms can also be recognized by their specific byproducts that are not part of human metabolism.]  Diflucan, Sporonox, Nizoral and Lamisil were all effective, but Diflucan has been castrated by the FDA's ill-advised decision to allow treatment of chronic vaginitis by a one-day course of therapy, which has  led to the rapid emergence of resistant strains - most of those patients need a month of intensive diet, probiotics and systemic antifungals.  Occasionally IV Amphotericin has been necessary.  Some newer agents are not out long enough to be safe despite FDA approval, in my opinion.  Since the recent reports from Germany, showing that Diflucan has Lyme suppressive effects, I have been using Diflucan in large doses [400 mg h.s. for a month] as initial therapy for new or unconfirmed chronic/late Lyme as part of an intensive program to restore healthy colonic flora, while waiting for the results of the Lyme workup.  It will cause a Herx from heavy candida alone, so it can't be relied on as being indicative of the Lyme Herx. In addition to creating the resistant strains of Candida, the inadequate use of systemically active antifungals and the overuse of antibiotics singly and in combination have led to an increase in the incidence of Candida glabrata [aka Torulopsis glabrata], C. krusei and other strains which can be very resistant to antifungal therapy as well. There are herbal products that are useful in early cases, such as garlic, oregano, caprylic acid and others.  An alkaline diet and alkalinizing supplements such as SuperGreens are very supportive.