The wet prep revealed pseudohyphae with budding, the hallmark of a candida infection; the patient was given a diagnosis of vulvovaginal candidiasis (VVC).
VVC is a common fungal infection in women of childbearing age; it is not a sexually transmitted disease. Patients with VVC will complain of pruritus, accompanied by a thick, odorless, white vaginal discharge.
Based on clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated:
- Uncomplicated VVC is characterized by sporadic or infrequent symptoms that are mild to moderate. Patients are not immunocompromised.
- Complicated VVC is characterized by recurrent (≥4 episodes in one year) or severe VVC and may involve non-albicans Candidiasis, or a patient who has uncontrolled diabetes, debilitation, or immunosuppression.
Treatment options include topical over-the-counter azole antifungal creams and a single dose of fluconazole 150 mg orally. In this case, the patient bought over-the-counter antifungal cream and her symptoms cleared quickly.
Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Candida vulvovaginitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:499-503.
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