Question of the Week # 452

Your patient is a gravida 2 para 2 female with a complaint of a vaginal discharge, vulvar irritation, and dysuria. Her symptoms have recurred 4 times within the past year. She had a recent urinary tract infection that was treated with ciprofloxacin, but is in otherwise good health. She is afebrile with normal vital signs, and pelvic examination reveals vulvar and vaginal erythema with a thick white discharge in the vaginal vault. KOH prep reveals pseudo hyphae. Which of the following treatments is most appropriate for this patient?


a. Oral fluconazole 150 mg x 1
b. Probiotic lactobacilli
c. No treatment is necessary
d. Oral Fluconozole induction followed by maintenance.
e. Topical miconazole x 7 days

11 Responses

  1. e

  2. A oral fluconazole

  3. A

  4. A

  5. e. Topical miconazole x 7 days

  6. Correct answer is D

  7. Patient has had 4 candida infections in the past and this is the fifth. More than 4 per year meats criterion for recurrent candida infection. So give not just immediate treatment, but also maintenance which I believe is 150 mg PO weekly. Not 100% sure.

  8. Well actually I would like to correct myself. The four previous episodes have not been documented as candida. So this should be considered as fort episode and answer would be a just treat this one time.

  9. I think it is a recurrent monilial infection and answer is D

  10. Answer is D recurrent vulvovaginal candidiasis should be treated with immediate plus maintenance therapy with oral fluconazole.

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