Patient Case 3 Vaginal Candidiasis

What is the usual symptom presentation of a patient with vulvovaginal candidiasis (VVC)?

Pruritis, pain, burning, irritation, dysuria ± erythema, edema

What is the usual symptom presentation of a patient with bacterial vaginosis?

± Irritation, dysuria, pruritis

What is the usual symptom presentation of a patient with trichomoniasis?

Pruritis, irritation, dysuria ± erythema, edema. May be asymptomatic.

What is the usual discharge presentation of someone with VVC?

Thick, white, curd- like, no odor

What is the usual discharge presentation of someone with bacterial vaginosis?

Thin, watery, off- white/discolored, malodorous (“fishy”), may be foamy

What is the usual discharge presentation of someone with trichomoniasis?

Copious, malodorous, yellow- green, frothy

What is the usual vaginal pH range of a healthy patient?

4.5

What is the usual vaginal pH range of a patient with VVC?

~4.5 (same as healthy pH)

What is the usual vaginal pH range of a patient with bacterial vaginosis OR trichomoniasis?

> 4.5

What class of medications is considered first-line pharmacological treatment for VVC?

Imidazole Antifungals

If a patient presents with bacterial vaginosis or trichomoniasis, what is the best course of action?

Medical referral

What are the three imidazole antifungal medications used to treat VVC?

Clotrimazole cream (1-2%), Miconazole Nitrate, Tioconazole 6.5% ointment

What is the typical dosing regiment for Clotrimazole 1% cream?

1 applicatorful PV QHS

What is the typical dosing regiment for Clotrimazole 2% cream?

1 applicatorful PV QHS

What is the typical duration of treatment for Clotrimazole 1% cream?

~7 days

What is the typical duration of treatment for Clotrimazole 2% cream?

~3 days

What is the typical dosing regiment for Tioconazole 6.5% ointment?

1 applicatorful PV HS (single dose)

What is the typical dosing regiment for Miconazole nitrate 1200 mg ovule + 2% cream?

1 ovule PV (single dose) + apply cream to vulva BID prn

What is the typical dosing regiment for Miconazole nitrate 200 mg suppository/ovule + 2% cream?

1 ovule/suppository PV QHS + apply cream to vulva BID prn

What is the typical dosing regiment for Miconazole nitrate 4% cream?

1 applicatorful PV QHS

What is the typical duration of treatment for Miconazole nitrate 200 mg suppository/ovule + 2% cream AND 4% cream?

~3 days

What is the typical duration of treatment for Miconazole nitrate 2% cream?

~7 days

If a patient presents with both internal and external symptoms of VVC, what is considered the strongest medication?

Combination medication (e.g. Miconazole nitrate 200 mg suppository/ovule + 2% cream)

If cost is not considered an issue, what treatments for VVC do most patients prefer?

Shorter treatments leading to higher patient compliance

What is the general dosing regiment for all cream/ointment formulations in treatment of VVC?

1 applicatorful PV QHS

What are typical key patient counseling points associated with imidazole antifungal medications?

No sex, no use of tampons ~3 d after use, can be used during/outside of menstruation, continue full therapy, preferably QHS

What are considered exclusions in self-treatment of VVC?

Comorbidity (e.g. diabetes), concurrent antibiotic use