Oral and vaginal thrush

Question 1

Candida is a genus of yeast and it is the most common cause of __________.

Answer 1

Candida is a genus of yeast and it is the most common cause of fungal infections.

Question 2

Candida is responsible for a wide range of infections including:

Answer 2

Vaginal Thrush
Oral Thrush
Systemic Infection
Meningitis
Abscess formation

Question 3

treatment for For most women

Answer 3

An initial course of an intravaginal antifungal cream or pessary (clotrimazole, econazole, miconazole, or fenticonazole) would be suitable.

An oral antifungal (fluconazole or itraconazole) may be considered after discussions with the patient.

Question 4

treatment for For women aged 60 years and older

Answer 4

Oral antifungals may be more acceptable than intravaginal antifungals because of the ease of administration.

Question 5

treatment for For girls aged 12–15 years

Answer 5

Topical clotrimazole 1% or 2% applied 2–3 times a day is considered suitable, or seek specialist advice. Do not prescribe an intravaginal or oral antifungal.

Question 6

treatment for For breastfeeding women

Answer 6

initial course of intravaginal clotrimazole or miconazole would be a suitable treatment option if the patient agrees.

Oral fluconazole (only if an intravaginal antifungal is unacceptable to the woman and the patient has been counselled).

If the patient is also experiencing vulval symptoms, use a topical imidazole in addition to an oral or intravaginal antifungal.
Clotrimazole 1% or 2% cream applied 2–3 times a day

Question 7

Candida infections in male patients often results in __________,

Answer 7

Candida infections in male patients often results in balanitis,

Question 8

The symptoms of balanitis include:

Answer 8

Swelling (sometime present)
Soreness, itch and odour.
This type of infections normally affects uncircumcised men, however can also occur in younger boys.

Question 9

Treatment options for balanitis include:

Answer 9

Creams and ointment - antifungal creams with steroids (Fluconazole).
Good hygiene.
Careful use of soaps and body washes, as these can cause problems (irritants).
Patients experiencing recurrent balanitis may need to consider circumcision.

Question 10

symptoms of oral thrush

Answer 10

Erythema of the hard palate present

Quite sore and inflamed

Question 11

Patients’ treatment with oral thrush

Answer 11

Fluconazole
Miconazole
Nystatin

Question 12

At risk conditions include:

Answer 12

HIV – Disease of the immune system
Patients receiving treatment for cancer – chemotherapy
Diabetes - due to increased levels of glucose in secretory fluids.
Malnutrition - this can also predispose to infections.
Extremes of age - having an insufficient immune response (due to being very young or older) can predispose you to infections.

Question 13

For immunocompromised patients, the decision would be different.
Immunocompromised patients often receive prophylactic antifungals. These include:

Answer 13

Fluconazole
Itraconazole
Posaconazole
Caspofungin

Question 14

Angular Cheilitis is an inflammatory condition affecting the corners of the mouth due to:

Answer 14

Dribble of saliva causing eczematous cheilitis, a form of contact irritant dermatitis.
Overhang of upper lip resulting in deep furrows Dry chapped lips.
These elements can lead to the proliferation of bacteria (impetigo), yeasts (thrush) or virus (cold sores). The symptoms experienced by the patients include:

Painful cracks / fissures.
Blisters / erosions / ooze / crusting.
Redness
Occasional bleeding

Question 15

Treatment of Angular Cheilitis

Answer 15

Miconazole cream for infections associated with Candida
Fusidic acid ointment for infections associated with Staphylococcus
Miconazole plus hydrocortisone cream or ointment if treatment with the first two options is unsuccessful.

Question 16

It is also important to remember that there are non-infectious causes of angular cheilitis and these include:

Answer 16

Irritation caused by saliva, sun exposure and smoking.
Allergens such as toothpaste, make up and different types of food.
Nutritional factors such as an iron deficiency.
Poor immune function
These must be taken into consideration and the patient counselled accordingly.

Question 17

Intertrigo is often caused by a ________

Answer 17

Intertrigo is often caused by a yeast infection

Question 18

Intertrigo is often caused by a yeast infection. This is often associated with areas of the body that have touching skin, such as:

Answer 18

Armpits
Groin
Under patients breasts
Within fat folds
Bottom - particularly associated with nappy rash

Question 19

Risk factors for intertrigo include:

Answer 19

Hot humid weather
Poor hygiene
not drying the area completely after showering or bathing
Tight fitting clothing
Inflammation of the skin, this is particularly associated with skin folds.
If the patient is using topical steroids.