Question

A 25 year old student presents with three days of vulvar pruritis. She has had a total of six lifetime partners, and is currently sexually active with one partner and states that they ""occasionally"" use condoms. One year ago, she was successfully treated for a Chlamydia infection. The patient denies vaginal odor or increased vaginal discharge. Physical exam reveals slight vulvar erythema, and speculum exam shows moderate clumpy white discharge. Vaginal discharge pH is 4.0. Whiff test is negative. Wet mount results: KOH prep shows occasional budding yeast and hyphae. Saline prep shows 3 WBCs, occasional squamous cells, and no bacteria. What is the next best step in the management of this patient?

A. Clotrimazole vaginal cream
B. Azithromycin and recommend that her partner see a physician for Chlamydia screening and treatment
C. Metronidazole
D. Ceftriaxone
E. Reassurance and f/u in 2 weeks

Answer 1

The best management for the patient's symptoms and diagnostic findings is the application of clotrimazole vaginal cream, which is a topical antifungal medication indicated for the treatment of vaginal candidiasis.

Step-by-step explanation:

The next best step in the management of this patient, who presents with vulvar pruritus and a moderate clumpy white discharge, is the use of clotrimazole vaginal cream (Option A). Given the vaginal discharge pH of 4.0, negative whiff test, and the presence of budding yeast and hyphae on KOH prep, the diagnosis is likely vaginal candidiasis. This fungal infection is best treated with antifungal medications rather than antibiotics or other treatments.

Candidiasis is a common condition, often presenting with symptoms like itching, burning, and a cottage cheese-like discharge. It can be diagnosed through microscopic examination of the discharge, and in this case, confirmed by the wet mount results. Topical antifungal treatments like clotrimazole are effective in managing candidiasis. Since the symptoms described by the patient are indicative of a yeast infection and not a bacterial STI or Trichomonas infection, antibiotics such as azithromycin (option B) or metronidazole (option C), and STD treatments like ceftriaxone (option D) are not appropriate. Reassurance and follow-up in 2 weeks (option E) would be neglecting to treat an active infection.