Case 093: Superficial Fungal Infections

PATIENT PRESENTATION

Chief Complaint

Vaginal irritation

History of Present Illness

MM, a 37-year-old woman, presents to the clinic with a chief complaint of thick vaginal discharge and vaginal itching and burning. Her symptoms initially presented 10 days ago. She tried an OTC antifungal that initially seemed to work, but never experienced complete symptom resolution. Today she reports the irritation, discharge and itch are beginning to worsen.

She reports the vaginal cream as difficult to use and would prefer an alternate option if possible.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. Is this patient suffering from VVC? What patient-reported symptoms and characteristics led you to that decision?

   Hint: See Vulvovaginal Candidiasis in PPP

2. What treatment options are available to treat vulvovaginal candidiasis?

   Hint: See Vulvovaginal Candidiasis and Table 85-2 in PPP

3. Does this patient have any risk factors for the development of VVC?

   Hint: See Vulvovaginal Candidiasis and Table 85-1 in PPP

4. What information does the use of a vaginal pH kit provide?

   Hint: See Vulvovaginal Candidiasis in PPP

5. What treatment options could be recommended if the patient were pregnant?

   Hint: See Vulvovaginal Candidiasis in PPP

FOLLOW-UP

Patient returns 8 months later. She has now had 4 VVC infections, which she has successfully treated with one-time oral fluconazole 150 mg. Is she a candidate for suppressive therapy, and if so, what treatment regimen would you recommend?

Hint: See Vulvovaginal Candidiasis in PPP

CASE SUMMARY

Global Perspective

Patients that have experienced female genital mutilation are being seen more frequently by health care providers. Female genital mutilation includes all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons, typically seen in Africa, Asia and the Middle East. Women who have undergone genital mutilation, also referred to as genital cutting, suffer acute and chronic complications, including dysmenorrhea, dyspareunia, and chronic vaginal infections including recurrent VVC. Regardless of the practitioner’s opinion on the practice, the practitioner must be sensitive to the patient’s feeling and cultural values.

Key References