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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"My private area is really itchy and sore. I think I have another one of those infections."

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History of Present Illness

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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.

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Past Medical History

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Type 2 DM, diagnosed 5 years ago

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Obesity

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Dysmenorrhea, diagnosed 10 years ago

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h/o UTI, diagnosed 4 days ago

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Family History

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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.

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Social History

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Single and lives with her sister; has no children. Has been unemployed for 5 years

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Tobacco/Alcohol/Substance Use

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Drinks 1–2 beers on the weekend; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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No known drug allergies

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Medications (Current)

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Glipizide 5 mg PO q 24 h

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Metformin 850 mg PO q 24 h

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Ortho Tri-Cyclen LO PO q 24 h

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Review of Systems

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General
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Well-appearing, obese Caucasian woman in no acute distress

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Vital Signs
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BP 124/69 mm Hg, P 68, RR 14, T 36.2°C (97.2°F)

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Weight 175 lb (80 kg)

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Height 66 in. (168 cm)

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Denies pain

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Skin
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Dry-appearing skin; ...

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