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PATIENT CARE PROCESS

Patient Care Process for Vulvovaginal Candidiasis

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Collect

  • Patient Characteristics (age, pregnancy status)

  • Patient medical history (previous vaginal infections, diabetes mellitus)

  • Social history (sexual activity)

  • Current Meds (oral contraceptives, antibiotics)

Assess

  • Symptoms consistent with VVC (itching, clumpy white vaginal discharge)

  • Absence of fever, pelvic pain, colored or foul smelling vaginal discharge

  • Possibility of sexually transmitted disease

  • Recurrence of symptoms from previous vaginal infection

Plan

  • Remove predisposing risk factors if possible

  • Select a drug therapy regimen including specific antifungal(s) dose, route, frequency, and duration (Table 120-2)

  • Education of the patient regarding causes of VVC and the selected treatment

  • Referral to other health care providers if complicated or recurrent VVC or risk factors for sexually transmitted disease

Implement

  • Provide patient counselling (avoid harsh soaps, perfumes, hot tub use, contraceptive use)

  • Keep vaginal area clean and dry avoid constrictive clothing

  • Self-assessment of symptom relief is appropriate

Follow-up: Monitor and Evaluate

  • Monitor for complete resolution of symptoms within 24-48 hrs of initiation of therapy (itching, clumpy white discharge)

  • Determine the presence of adverse effects (nausea, abdominal discomfort, vaginal irritation)

  • Refer to other health care provider if symptoms do not resolve despite adherence

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Vulvovaginal candidiasis (VVC) is a fungal infection of the vagina that can be classified as uncomplicated or complicated. This classification is useful in determining appropriate pharmacotherapy.

  • Image not available. Candida albicans is the major pathogen responsible for VVC. The number of cases of non-C. albicans species appears to be increasing.

  • Image not available. Signs and symptoms of VVC are not pathognomonic, and reliable diagnosis must be made with laboratory tests including vaginal pH, saline microscopy, and 10% potassium hydroxide (KOH) microscopy.

  • Image not available. C. albicans is the predominant species causing all forms of mucosal candidiasis. Important host and exogenous risk factors have been identified that predispose an individual to the development of mucosal candidiasis. In oropharyngeal and esophageal candidiasis, the key risk factor is impaired host immune system.

  • Image not available. Topical antimycotic agents such as nystatin or clotrimazole are the first choice for treating oropharyngeal candidiasis (OPC). Systemic therapy can be used in patients who are not responding to an adequate trial of topical treatment or are unable to tolerate topical agents and in those at high risk for systemic candidiasis. Fluconazole and itraconazole remain first line antimycotic agents.

  • Image not available. For esophageal candidiasis, topical agents are not of proven benefit; fluconazole or itraconazole solution is the first choice.

  • Image not available. Optimal antiretroviral therapy is important for the prevention of recurrent and refractory candidiasis in patients with human immunodeficiency virus (HIV) infection.

  • Image not available. Primary or secondary prophylaxis of fungal infection is not recommended routinely for HIV-infected patients; use of secondary prophylaxis should be individualized for each patient.

  • Image not available. Topical antimycotic agents are first-line treatment for fungal skin infections. Oral therapy is preferred for the treatment of extensive or severe infection and those with tinea capitis or onychomycosis.

  • Image not available. New topical antifungal agents efinaconazole and tavaborole are recommended for mild-moderate toenail fungal infections.

Superficial ...

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