CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of vaginal candidiasis
Identify the goals of therapy for vaginal candidiasis
Develop an appropriate treatment and monitoring plan for vaginal candidiasis on the basis of individual patient characteristics
Select an appropriate product for vaginal candidiasis therapy
Properly educate a patient receiving vaginal candidiasis therapy
"My private area is really itchy and sore. I think I have another one of those infections."
History of Present Illness
Lilly Hayes is a 39-year-old woman who presents to the physician's clinic complaining of severe vaginal itching and soreness, accompanied by a thick vaginal discharge. Her first visit to the clinic was 4 days earlier for an Escherichia coli UTI. For the UTI, she was prescribed ciprofloxacin 250 mg twice daily for 3 days. After initiating the antibiotic therapy, the patient noted the development of the vaginal discharge, followed by vaginal itching and soreness. Although records are not currently available from her previous physician, the patient reports a history of recurrent vaginal candidiasis, including five episodes in the last year (excluding this episode). She expresses frustration with the repeated infections, especially since she cannot afford over-the-counter medications and therefore must make time to go to the physician's office to get a prescription medication that is covered on her assistance plan.
Type 2 DM, diagnosed 5 years ago
Dysmenorrhea, diagnosed 10 years ago
h/o UTI, diagnosed 4 days ago
Father is alive at age 65 with no significant medical history. Mother had DM, dyslipidemia, CAD, and died of complications due to DM at age 60. She has one sister who is 44 and has type 2 DM.
Single and lives with her sister; has no children. Has been unemployed for 5 years
Drinks 1–2 beers on the weekend; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Metformin 850 mg PO q 24 h
Ortho Tri-Cyclen LO PO q 24 h
Well-appearing, obese Caucasian woman in no acute distress
BP 124/69 mm Hg, P 68, RR 14, T 36.2°C (97.2°F)