Vaginal thrush

• is this for yourself, would you be more comfortable going to consultation room to talk about this

• what symptoms have you been experiencing

• how long are the symptoms been present

• have u experienced this before

• have u tried anything to treat this

• do u have any medical conditions

• are u taking any medications or any vitamins or supplements at the moment

• do u have any allergies

• To pick the best treatment for you, is there a possibility that you may be pregnant or breastfeeding?

WHAMMA P/B

• can you describe your discharge

• do you experience any itchiness

• do you experience any pain when urinating

• to help pick the best treatment for you, I have to ask, are you sexually active, if so do you experience any pain during intercourse?

• do you experience a burning sensation

symptom based

• do you use any contraceptive devices like IUD

• do you use any fragrances washed in that area

• how has your diet been recently

• is your underwear tighly fitted

• how often to do change your pad

trigger based

• have you spoken to the doctor about this?

• have you experienced any abdominal pain

• any fever recently

• have you experienced any unusual bleeding

referral based

• I believe you may have vaginal thrush, this is caused by the overgrowth of a normal yeast found in the vagina, this is very common and we can treat it and it is not a sexually transmitted disease.

• This is usually caused by a disruption in the normal bacteria of the vagina, which can cause an increase in the pH

• It is associated with itchiness, cottage cheese like discharge, a possible odour but not very strong, if odour it smells like bread

• This is commonly due to iron deficiency, pregnancy, diabetes, being on antibiotics or caused by using perfumed products or tight underwear

• do you have any preferences in how you want to treat this condition

NELT

• based on your preferences - if pregnacy dont use cream, use pessary. As applicator is not safe for pregnancy especially in 3rd trimester and no oral tablet or capsule if pregnant or breastfeeding

• pessary - clotramizole pessary 100mg or 500mg - 6 or 1 night

• cream - 1%, 2%, 10% - 6 nights, 3 nights, 1 night

• single dose - fluconazole (if topical not tolerated) -one tablet any time of the day with or without food, you won’t get immediate symptom relief - not if on warfarin, anticoagulants, cyclosporin, phenytoin or heart issues

• fluconazole tablet with cream - Apply gently to the irritated area two to three times daily until symptoms clear

• this is anti-fungal which will help to inhibit the growth of the yeast

• Nystatin cream for 14 nights

• ask if they are familiar with using it, if not mentioned

• adverse effects - may cause a bit of stinging or irritation for vaginal creams

• tablet - wel tolerated

• refer - recommend visiting the doctor if you get this more than 4 times a year, the symptoms dont seem to clear after one week of the symptoms, any abnormal discharge or fever or if symptoms get worse

• in the future - recommend wiping front to back to prevent introduction of bacteria to the vagina, urinating before and after sex to flush the semen out of the vagina, as semen has a high pH and vagina has a low pH, which could disrupt the pH, prevent flushing the vagina too much water and prevent using fragrances

• do you think this works for you

IDARL

• topical wont be absorbed in blood stream

• use of perfumed washes

• applicator safe in preg

• oral tablet is safe in preg/lactation

common myths