Exam 2 - VVC Flashcards
Where is candida normally found on exam?
Vagina, vulva, groin, moist areas and skin folds
Causative organism
Candida albicans - overgrowth of yeast
Uncomplicated vs complicated VVC infections
- Have mild to moderate symptoms
- Occur infrequently
- Common
Uncomplicated vs complicated VVC infections
- Occur more than 4x a year
- Severe symptoms
- Common in women who are immunocompromised
VVC: risk factors
- Wearing non-breathable, tight fitting clothes
- Living in humid climates
- Pregnancy
- Use of COCs and steroids
- Diabetes
- Recent use of antibiotics in immunocompromised states
- Alter vaginal flora allowing proliferation of candida
VVC: physical exam findings
- Thick, white, curd-like vaginal discharge (“cottage cheese”)
- Can also be thin and watery, adhere to vaginal walls
- Erythematous, swollen red vulva/vagina
- Vaginal itching, dysuria, dyspareunia
Severe candidiasis presentation
Svere erythematous skin, fissures, edema, excoriations
- Significant rashes and discharge
VVC: lab testing
KOH preparations reveals budding yeast (blue arrow) and hyphae (red arrow)
- KOH breaks down cell walls and removes epithelial cells –> leaves yeast exposed to be easily seen
Can you diagnose VVC without the presence of hyphae?
Yes - lack of hyphae does not rule out candidiasis diagnosis
- Can obtain fungal culture and treat empirically
VVC: general treatment
Many OTC available, no standard recommendations for best therapy available
- Topicals
- Systemic antifungals for mild, severe, and recurrent cases
VVC: patient education
- Reduce vulvar moisture to decrease yeast growth
- Douching NOT recommended
- Probiotics (e.g. lactobacillus) may restore normal vaginal flora
VVC: treatment for mild to moderate infection
Topical: clotrimazole, miconazole, Nystatin, terconazole
Systemic antifungals: fluconazole
- Does not require handling of genitals
- Systemic effects include alteration in hepatic function
VVC: treatment during pregnancy
Topical azole for 7 days
VVC: treatment for severe infections
- Topical azole for 7-14 days
- Fluconazole (second dose taken 72 hours after initial dose)
- Nystatin
- Successful in treating azole-resistant candida and non-albicans candida infection
- Boric acid (applied vaginally)
VVC: treatment for recurrent candidiasis
Defined as more than 3-4 episodes per year
Predisposing factors
- Undiagnosed or inadequately treated diabetes
- Chronic use of antibiotics or corticosteroids
- Candidiasis in male partner
- HIV infection
Culture yeast in abscence of predisposing factors
