Questions to ask the patient
How frequent do you clean your body?
How many sexual partners do you have?
Have you ever been diagnosed of vaginal infection before?
Do you feel pain in any other part of the body?
What do you use for vaginal cleaning?
Do you share underpants with anyone else?
Do you use the public toilet seats?
The questions above are important because they allow for the assessment of the patient as a way
of establishing the cause of vaginal infection. An understanding of the cause of an infection will
play an important role in the identification of the causes of the infections and in so doing, the
doctor will advise the patient on what she needs to prevent such infections in the future.
Pertinent and positive information
ID: The patient is a 32 year old female with insulin dependence diabetes.
CC: Vulvo-vaginal itching
HPI (History of Present Illness) Two years ago she underwent a pap smear which turned out
normal. She c/o a constant perineal itch and a white thick vaginal discharge which she has had
for 2 weeks. She was treated with a topical vaginal cream for a recurrent vulvo-vaginal infection
in the past. The itching subsided for several months, however has returned. Four days ago, the
patient used an over the counter external preparation with no relief. She has no other complaints.
Current medication: Topical vaginal cream for a recurrent vulvo-vaginal infection
Childhood illness: No record of childhood illness.
Family history: No record for family history.
Social history: No record of social history.
Differential and working /final diagnosis with rationale and pathophysiological
In the process of diagnosis the doctor will ask the patient if she has any vaginal itching, assess
any change in the amount of vaginal discharge, assess the color of the vaginal discharge, ask the
patient if she feels any pain during urination and sexual intercourse. The doctor will also will
also look out for any signs of vaginal bleeding or spotting (Martinez et al., 2009).
In the lab, the doctor will use the Speculum to assess any inflammation or abnormal vaginal
discharge. Any inflammation in the vagina will confirm the presence of infections. The doctor
will also take a sample if the vaginal discharge carry out microscopy to identify the kind of
infection that the patient has. It may be bacterial, viral or fungal. Microscopy will enable the
doctor to identify the type of parasite in question and its effects. According to the diagnosis, the
patient has a fungal infection shown by the presence of numerous hyphae. The test for bacterial
infection turned out negative (Martinez et al., 2009).
Advice the patient to use precautionary measures such as preventing sharing undergarments,
toiletries, clean the body frequently and to prevent having many sexual partners and insist on
protection when having sexual intercourse. The patient is also advised to make sure that her
clothes are well washed and dried in the sun as a way of killing the fungi and making a hostile
environment for the fungi to survive. These precautionary measures will prevent further infection
and may protect the other people living with the patient from the infection. The doctor will
prescribe a single oral dose of fluconazole (Diflucan) for the treatment of the fungal infection. It
should be noted that the oral medication is not recommended when the patient is pregnant. The
oral medication will be complemented by short-course vaginal therapy that involves the applying
antifungal cream in the vaginal area. The patient will come back after a week of treatment for
assessment. In the case where the short course-vaginal therapy is not working as expected, then
the patient will have to be put on a long-course vaginal therapy for further 2 weeks (Sobel,
Martinez, R., Franceschini, S., Patta, M., Quintana, S., Candido, R., Ferreira, J., … Reid, G.
(2009). Improved treatment of vulvovaginal candidiasis with fluconazole plus
probioticLactobacillus rhamnosusGR-1 andLactobacillus reuteriRC-14. Letters in
Applied Microbiology, 48(3), 269-274. doi:10.1111/j.1472-765x.2008.02477.x
Sobel, J. D. (2016). Recurrent vulvovaginal candidiasis. American Journal of Obstetrics and
Gynecology, 214(1), 15-21. doi:10.1016/j.ajog.2015.06.067