Vulvovaginal Candidiasis

Pt with h/o DM and immunocompromised state presents with white vaginal discharge. Reports vulvar itching/burning but denies presence of odor. Medications include corticosteroids and recent course of antibiotics. Vulvar erythema and thick/white/curd-like vaginal discharge on exam.

• Hyphae noted on microscopy with KOH prep

• Discharge sent for culture

• Treatment

  • Non-pregnant patient

    • Send two doses of fluconazole 150 mg PO to pharmacy

    • Administer 1 dose fluconazole today

    • Pt advised to take second dose in 1 week if symptoms have not resolved

  • Pregnant patient: Administer miconazole 2% cream 5 g intravaginally daily for 7 days

Notes

• 25% of vaginitis cases

• Consider offering prophylactic oral fluconazole when starting women on antibiotics

• Complicated vulvovaginal candidiasis

  • Defined as

    • Four or more infections in 1 year

    • Infection in women with poorly controlled DM or AIDS

    • Severe infection

  • Send for culture as infection is more likely to be caused by non-albicans Candida