thrush Flashcards
what is the main fungal organism responsible for VVS
a) candida glabrata
b) candida tropicalis
c) candida albicans
d) candida krusei
c) candida albicans - responsible for 80-89% of VVS candida
You are fitting an IUD in the contraception clinic and whilst doing it you notice a thick white discharge and suspect VVC. The patient is asymptomatic. You take VVC swab and this confirms the diagnosis of the presence of candida albicans. What is the best treatment option?
a) stat dose fluconazole 150mg
b) stat dose clotrimazole pessary 500mg PV
c) do nothing - reassure patient, as long as asymptomatic no treatment required
d) nystatin pessary 100,000 units for 14 days
c - do nothing; 10-20% of women will harbour candida asymptomatically and they don’t require treatment
What percentage of women with VVS candida will go on to develop recurrent disease?
a) 1%
b) 6%
c) 15%
d) 50%
b - 6%
define acute VVS
this is the initial episode of vvs candida
what is the definition of recurrent VVS? how many times in a year does a patient need to have had candida for it to be called recurrent VVS
recurrent VVS is defined as >= 4 episodes of VVS with at least two episodes being confirmed by microscopy and or culture. And at least one of them being diagnosed on culture showing moderate to heavy growth.
Candida are found on the healthy vagina flora?
True or false
True - candida are found on the healthy vaginal flora. only when overgrowth occurs can infection develop
List three risk factors for developing VVC
- immunodeficiency - in particular MBL deficiency has been found to be linked to VVC
- poorly controlled DM
- recent (within the last 3 months) use of antibiotics
- endogenous or exogenous oestrogen (pregnancy, HRT and possible COCP but weak evidence to support this)
what percentage of women will have at least one episode of VVS candida in their lifetime?
a) 25%
b) 50%
c) 75%
d) 90%
c - 75%
name two non-albican species
candida glabrata and candida krusei
candida krusei is resistant to which treatment
a) fluconazole
b) nystatin
c) amphoceterin
d) boric acid
a - fluconazole
what percentage of women who present thinking they have ‘recurrent thrush’ actually have this diagnosis?
a) 25%
b) 50%
c) 70%
d) 90%
b - 50%
only 50% of women who believe they have recurrent thrush actually have it
consider other differential diagnosis e,g. BV, atrophic vaginitis in peri or post-menopausal woman, lichen sclerosis, vulval dermatoses e.g. lichen simplex or eczema
a 55 year old female presents with continuous itch symptoms, her GP has been treating her for thrush with fluconazole as and when she has the symptoms. Looking at her results she has never had a confirmed culture or microscopy result for VVS. She denies any abnormal discharge but a really awful itch that is worse at night. She is not on HRT and is having monthly periods.
On examination - there is no obvious discharge but evidence of pale mucus membranes and visibly loss of architecture to the clitoris.
what is the most likely diagnosis?
a) acute VVS
b) genital eczema
c) recurrent VVS
d) lichen simplex
e) lichen sclerosus
e - lichen sclerosus
always consider differential diagnosis especially in women with symptoms of itch failure to improve with treatment.
what are the signs suggestive of acute VVS that you might see on examination?
erythema, fissures and excoriation marks
satelite lesions
sometimes oedema of the labia
white thick non offensive discharge
Lydia comes to clinic worried about whether she has an STI. She has had new vaginal discharge for the past week. She describes it as thick white discharge associated with an itch.
What is the best method to confirm the diagnosis?
a) VVS culture
b) VVS dry microscopy
c) VVS NAAT
d) urine MC&S
e) VVS wet microscopy
b ) VVS dry microscopy
BASHH guidelines suggest the best method to confirm diagnosis of VVS candida is through microscopy; however if this is not available then consider VVS culture but not necessary for treatment
Lydia comes to clinic worried about whether she has an STI. She has had new vaginal discharge for the past week. She describes it as thick white discharge associated with an itch. Her VVS microscopy in clinic demonstrates the presence of hyphae and pseudo spores. She is not allergic to any medication and is on the COCP rigvedon for contraception with no missed pills.
What is the first line treatment
Fluconazole 150mg stat PO (if pregnancy or BF then clotrimazole pessary 500mg PV)
Lydia comes to clinic worried about whether she has an STI. She has had new vaginal discharge for the past week. She describes it as thick white discharge associated with an itch. Her VVS microscopy in clinic demonstrates the presence of hyphae and pseudo spores. She is not allergic to any medication and is on the COCP rigvedon for contraception with no missed pills.
You treat her with fluconazole 150mg stat, What general advice should you also give?
avoid soaps and shower gels, wash with a soap substitute
use emollients and emollient washes e.g.. E45 cream, hydromol etc
wear cotton breathable underwear
Lydia comes back to clinic. She has had multiple episodes of thrush and usually self treats for these buy buying over the counter cannesten duo. Initially this helped her symptoms, but now she feels she doesn’t get any improvement in her symptoms after treatment.
How should you investigate this?
consider recurrent thrush
she needs a genital examination to confirm or diagnose the condition and rule out other possible diagnoses
do a VVS for MC&S - ask for candida typing and sesnsitivities
consider investigating for DM, IDA - random BG, or urine to look for glycosuria and FBC to investigate for IDA
Lydia comes back to clinic. She has had multiple episodes of thrush and usually self treats for these buy buying over the counter cannesten duo at least 6 other the past 12 months. She came previously microscopy was positive for VVS. She feels it helps her symptoms but then they are quick to re-occur. She is on the COCP for contraception.
Her VVS demonstrates candida albicans - no resistance to azoles. RBG and FBC were normal.
How would you manage her symptoms?
a) induction - fluconazole 150mg for 3 doses every 72 hours, followed by maintenance 150mg once weekly for 6 months
b) induction - clotrimazole 500mg PV for 7 days, followed by maintenance clotrimazole 500mg PV once weekly for 6 months
c) induction- nystatin 100, 000 units PV for 14 nights, followed by maintenance nystatin pessaries 14 consecutive nights every month for 6 months
d) induction - boric acid 600mg pessaries for 14 consecutive nights, followed by maintenance boric acid 600mg pessaries for 14 nights every month for 6 months
answer - a
diagnosis of recurrent thrush as she has had at least 4 episodes in the last 12 months. With 2 confirmed episodes on microscopy and culture.
no resistance to azoles therefore start with treatment line a
