Candida vulvovaginitis - Revision history

Rossdonaldson1: /* Management */

2024-06-19T22:33:29Z

Management

← Older revision		Revision as of 22:33, 19 June 2024
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	*Sexual partners should ''not'' be treated unless the patient has frequent recurrences		*Sexual partners should ''not'' be treated unless the patient has frequent recurrences
	*Does ''not'' need a test of cure		*Does ''not'' need a test of cure
	*Antifungal<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref>
	**1st line: Oral [[Fluconazole]]
	**Pregnant: Topical imidazole ([[clotrimazole]], [[miconazole]])

	===Antifungals===		===Antifungals===

Rossdonaldson1: /* Disposition */

2024-06-19T21:49:46Z

Disposition

← Older revision		Revision as of 21:49, 19 June 2024
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	==Disposition==		==Disposition==
	*Outpatient		*Outpatient
			**Refer all "complicated" cases to gynecology

	==See Also==		==See Also==

Rossdonaldson1: /* Evaluation */

2024-06-19T21:34:30Z

Evaluation

← Older revision		Revision as of 21:34, 19 June 2024
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	[[File:Vaginal wet mount of candidal vulvovaginitis.jpg\|thumb\|KOH test on a vaginal wet mount, showing slings of pseudohyphae of Candida albicans surrounded by round vaginal epithelial cells.]]		[[File:Vaginal wet mount of candidal vulvovaginitis.jpg\|thumb\|KOH test on a vaginal wet mount, showing slings of pseudohyphae of Candida albicans surrounded by round vaginal epithelial cells.]]
	===Work-up===		===Work-up===
	*Wet mount ~~- shows hyphae and yeast buds~~		*Urine pregnancy
	**Candida does not cause WBCs on wet mount → if ~~present, consider co-infection with other vaginitides or STI~~		*Wet mount
	*If recurrent, ~~consider checking blood glucose~~ for occult DM		*Consider blood glucose (if recurrent, to check for occult DM)
			*Consider tests for [[STIs]]

	===Diagnosis===		===Diagnosis===
	~~''Although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis''~~
	*Cotton cheese curd-like non-odorous vaginal discharge on pelvic exam		*Cotton cheese curd-like non-odorous vaginal discharge on pelvic exam
	*Vaginal pH < 4.5		*Vaginal pH < 4.5
	*Vaginal wet mount		*Vaginal wet mount
			**Hyphae and yeast buds
			**Candida does not cause WBCs on wet mount → if present, consider co-infection with other [[vaginitides]] or [[STI]]

	==Management==		==Management==

Rossdonaldson1: /* Diagnosis */

2024-06-19T21:31:40Z

Diagnosis

← Older revision		Revision as of 21:31, 19 June 2024
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	===Diagnosis===		===Diagnosis===
	*although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis		''Although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis''
	*~~cotton~~ cheese curd-like non-odorous vaginal discharge on pelvic exam		*Cotton cheese curd-like non-odorous vaginal discharge on pelvic exam
	*~~vaginal~~ pH < 4.5		*Vaginal pH < 4.5
	*~~vaginal~~ wet mount		*Vaginal wet mount

	==Management==		==Management==

Rossdonaldson1: /* Clinical FeaturesKauffmann CA. Overview of Candida Infections. UptoDate. 2016. */

2024-06-19T21:30:03Z

Clinical FeaturesKauffmann CA. Overview of Candida Infections. UptoDate. 2016.

← Older revision		Revision as of 21:30, 19 June 2024
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	**Poorly controlled [[diabetes]], immunocompromising conditions (such as [[HIV]]), debilitation, or immunosuppressive therapy (e.g., [[corticosteroids]])		**Poorly controlled [[diabetes]], immunocompromising conditions (such as [[HIV]]), debilitation, or immunosuppressive therapy (e.g., [[corticosteroids]])

	==Clinical Features~~<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>~~==		==Clinical Features==
	[[File:Candida vaginitis.JPG\|thumb\|Candida vaginitis]]		[[File:Candida vaginitis.JPG\|thumb\|Candida vaginitis]]
	*Vulvar [[pruritus]] - most common and specific symptom		*Vulvar [[pruritus]] - most common and specific symptom<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>
	*[[Vaginal discharge]] - varies from little to copious and from watery to cottage-cheese like		*[[Vaginal discharge]] - varies from little to copious and from watery to cottage-cheese like
	*Malodorous smell is unusual (if present favors diagnosis of [[Bacterial vaginosis]])		*Malodorous smell is unusual (if present favors diagnosis of [[Bacterial vaginosis]])
	*~~intense~~ vulvovaginal [[pruritus]] or burning		*Intense vulvovaginal [[pruritus]] or burning
	*~~dyspareunia~~		*Dyspareunia
	*[[~~dysuria~~]]		*[[Dysuria]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* TypesAdapted from ACOG practice bulletin */

2024-06-19T21:28:55Z

TypesAdapted from ACOG practice bulletin

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	===Types<ref>Adapted from ACOG practice bulletin</ref>===		===Types<ref>Adapted from ACOG practice bulletin</ref>===
	*Uncomplicated		*Uncomplicated (must have all)
	**Sporadic infection		**Sporadic infection
	**Mild-moderate symptoms		**Mild-moderate symptoms
	**Due to ''Candida albicans'' (suspected or proven)		**Due to ''Candida albicans'' (suspected or proven)
	**Immunocompetent		**Immunocompetent
	*Complicated		*Complicated (presence of ANY of the following)
	**'''Any species other than ''C. albicans'''''		**'''Any species other than ''C. albicans'''''
	**Recurrent infection (defined as ≥4 episodes per year)		**Recurrent infection (defined as ≥4 episodes per year)

Rossdonaldson1: /* Types */

2024-06-19T21:16:26Z

Types

← Older revision		Revision as of 21:16, 19 June 2024
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	*Can occur as a result of antibiotic use		*Can occur as a result of antibiotic use

	===Types===		===Types<ref>Adapted from ACOG practice bulletin</ref>===
	*Uncomplicated		*Uncomplicated
	**Sporadic infection		**Sporadic infection
	**Mild-moderate symptoms		**Mild-moderate symptoms
	**Due to ''Candida albicans''		**Due to ''Candida albicans'' (suspected or proven)
	**Immunocompetent		**Immunocompetent
	*Complicated		*Complicated
	**'''Any species other than ''C. albicans'''''		**'''Any species other than ''C. albicans'''''
	**Recurrent infection		**Recurrent infection (defined as ≥4 episodes per year)
	**Severe symptoms		**Severe symptoms or findings
	**~~Uncontrolled~~ [[DM]]		**Poorly controlled [[diabetes]], immunocompromising conditions (such as [[HIV]]), debilitation, or immunosuppressive therapy (e.g., [[corticosteroids]])
	**Immunosuppression
	**[[~~Pregnant~~]]

	==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>==		==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>==

Rossdonaldson1: /* Management */

2024-06-19T21:02:12Z

Management

← Older revision		Revision as of 21:02, 19 June 2024
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	==Management==		==Management==
	*Do not treat if asymptomatic		*Do ''not'' treat if asymptomatic
	*Sexual partners should not be treated unless the patient has frequent recurrences		*Sexual partners should ''not'' be treated unless the patient has frequent recurrences
			*Does ''not'' need a test of cure
	*Antifungal<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref>		*Antifungal<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref>
	**1st line: Oral [[Fluconazole]]		**1st line: Oral [[Fluconazole]]

Rossdonaldson1: /* Types */

2024-06-19T20:51:48Z

Types

← Older revision		Revision as of 20:51, 19 June 2024
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	===Types===		===Types===
	*Uncomplicated		*Uncomplicated
	**Sporadic ~~infectionn~~		**Sporadic infection
	**~~mild~~-moderate symptoms		**Mild-moderate symptoms
	**~~due~~ to Candida albicans		**Due to ''Candida albicans''
	**~~immunocompetent~~		**Immunocompetent
	*Complicated		*Complicated
			**'''Any species other than ''C. albicans'''''
	**Recurrent infection		**Recurrent infection
	**~~severe~~ symptoms		**Severe symptoms
	**~~uncontrolled~~ [[DM]]		**Uncontrolled [[DM]]
	**~~immunosuppression~~		**Immunosuppression
	**[[~~pregnant~~]]		**[[Pregnant]]

	==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>==		==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>==

Rossdonaldson1: /* Background */

2024-06-05T21:52:28Z

Background

← Older revision		Revision as of 21:52, 5 June 2024
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	[[File:Vulva Figure 28 02 02.jpg\|thumb\|Labeled vulva, showing external and internal views.]]		[[File:Vulva Figure 28 02 02.jpg\|thumb\|Labeled vulva, showing external and internal views.]]
	[[File:Blausen 0400 FemaleReproSystem 02b.png\|thumb\|Pelvic anatomy including organs of the female reproductive system.]]		[[File:Blausen 0400 FemaleReproSystem 02b.png\|thumb\|Pelvic anatomy including organs of the female reproductive system.]]
	*Local fungal infection caused by the [[Candida]] genus		*Local fungal infection caused by the [[Candida]] genus (most commonly [[Candida albicans]])
	*Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity, diabetes mellitus		*Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity, diabetes mellitus
	*Not considered an STI although it can be transmitted by sexual intercourse		*Not considered an STI although it can be transmitted by sexual intercourse