VVC Treatment

Question 1

Symptoms of VVC?

Answer 1

Redness
Itch
Abrasion
Thick curdish-like discharge (cottage-cheese)
Not foul smelling, no fishy odour

Question 2

Red flags for referral?

Answer 2

Foul smelling, fishy odour (May be suggestive of bacterial vaginosis, trichomoniasis)

Pregnancy

Ages < 12 years or > 60 years old

Recurrent VVC ≥ 4 x within 12 months

Recurrent VVC within 2 months

Medications like SGLT2i, uncontrolled DM, COC, HRT

Question 3

Differential Diagnosis

Answer 3

Bacterial vaginosis
Trichomoniasis
Vulvovaginal candidiasis
Latex or spermicide allergies

Question 4

List of treatment options for P-sales

Answer 4

1. Clotrimazole 500mg Pessary (Single dose)
2. Clotrimazole 100 mg Vaginal Tablet (1 tab QD for 6 days OR 2 tab QD for 3 days)
3. Isoconazole Nitrate 600 mg Pessary (Gyno-Travogen) (Single dose)
4. Fluconazole 150 mg Oral Capsule (Diflucan)

Question 5

Why is the use of latex condoms not recommended while using vaginal tablets or pessaries?

Answer 5

The pessaries or vaginal tablets are usually oil-based and can damage the latex

Question 6

What should you advise to deal with the melting of pessary in the vagina?

Answer 6

Use a non-scented panty liner to prevent soiling of the underwear

Question 7

Side effects of oral fluconazole?

Answer 7

Headache, nausea, vomiting, diarrhea, abdominal pain, rash

Rare: Angioedema, altered liver enzymes, lipid level changes, QTc prolongation, agranulocytosis