Candidiasis



Vulvovaginal CandidiasisINTRODUCTION Vulvovaginal candidiasis (VVC) is generally not sexually acquired or transmitted. Most uncomplicated infections are caused by Candida albicans, a dimorphic fungus that grows as oval budding yeast cells (commonly observed in vaginal secretions) and as pseudohyphae. Approximately 10%–20% of cases will have complicated VVC that necessitates special diagnostic and therapeutic considerations.SUBJECTIVE DATA History may include:Contraceptive method; condom/spermicide useRecent use of antibiotics, corticosteroids, or chemotherapyLNMP History of diabetes mellitus, HIV, or other immunocompromised conditionsSymptoms may include:Vulvar/vaginal pruritus, soreness, swelling, burningAbnormal vaginal discharge described as thick, white and cheesyDyspareuniaSymptoms may increase just prior to mensesIII.OBJECTIVE DATAPhysical exam findings:Females: inspection of vulva, vagina and cervix to assess for:curd-like, sticky discharge, erythema, swellingMales: inspection of penis, coronal sulcus, periurethral area and prepuce to assess for:-erythema, swelling and irritationASSESSMENTDiagnosis of candidiasis is made by laboratory testing:a wet preparation (saline, 10% KOH) or Gram stain of vaginal discharge demonstrating yeasts, hyphae, or pseudohyphae and showing no motile trichomonads or clue cellsa culture yields a positive result for a yeast speciesV.PLAN Treatment:Recommended RegimensOver-the-Counter Intravaginal Agents:Clotrimazole 1% cream 5 g intravaginally for 7–14 daysORClotrimazole 2% cream 5 g intravaginally for 3 daysORMiconazole 2% cream 5 g intravaginally for 7 daysORMiconazole 4% cream 5 g intravaginally for 3 daysORMiconazole 100 mg vaginal suppository, one suppository for 7 daysORMiconazole 200 mg vaginal suppository, one suppository for 3 daysORMiconazole 1,200 mg vaginal suppository, one suppository for 1 dayORTioconazole 6.5% ointment 5 g intravaginally in a single applicationPrescription Intravaginal Agents:Butoconazole 2% cream (single dose bioadhesive product), 5 g intravaginally for 1 dayORTerconazole 0.4% cream 5 g intravaginally for 7 days ORTerconazole 0.8% cream 5 g intravaginally for 3 daysORTerconazole 80 mg vaginal suppository, one suppository for 3 daysOral Agent:Fluconazole 150 mg oral tablet, one tablet in single dose (Avoid in Pregnancy)SPECIAL CONSIDERATIONS Compromised Host: Women with underlying debilitating medical conditions (e.g., those with uncontrolled diabetes or those receiving corticosteroid treatments) do not respond as well to short-term therapies. Efforts to correct modifiable conditions should be made, and more prolonged (i.e., 7–14 days) conventional antimycotic treatment is necessary.Pregnancy: VVC frequently occurs during pregnancy. Only topical azole therapies, applied for 7 days, are recommended for use among pregnant women.HIV Infection: The incidence of VVC in HIV-infected women is unknown. Vaginal Candida colonization rates among HIV-infected women are higher than among those for seronegative women with similar demographic characteristics and high-risk behaviors, and the colonization rates correlate with increasing severity of immunosuppression. Symptomatic VVC is more frequent in seropositive women and similarly correlates with severity of immunodeficiency. Persistent or chronic Infections: Clients who have persistent infections or chronic infections (3-5/year) should be managed by either referral or assessed for health conditions (i.e., diabetes, immune suppression, HIV).CLIENT EDUCATION/COUNSELING Creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms.Provide Medication information sheet Provide STD education information Offer other STD testingProvide current educational information on VVCProvide contraceptive information if requested VVC is usually not a sexually transmitted diseaseVIII. FOLLOW-UPUnnecessary if asymptomatic after medication treatmentQuestion client on resolution of symptoms at next clinic visitPatients should be instructed to return for follow-up visits only if symptoms persist or recur within 2 months of onset of the initial symptomsIX. REFERRAL Clients with persistent or chronic infectionsClients who are pregnant (refer to prenatal care)X.REPORTING Mandated state reporting is NOT required in MIReferences: CDC: Sexually Transmitted Disease Treatment Guidelines, 2015 Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories, 2017Reviewed/Revised: 2018 ................
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