A 24-year-old female presents with thick, white, clumpy 'cottage cheese' vaginal discharge accompanied by intense vulvar itching, erythema, and dysuria. Vaginal pH is measured at 4.2. Wet mount microscopy with 10% KOH reveals budding yeast and pseudohyphae. What is the first-line treatment?
Answer and explanation
Correct answer: D. Topical or oral antifungal therapy (e.g., oral fluconazole 150 mg single dose)
- Step 1: Vulvovaginal candidiasis (most commonly Candida albicans) thrives in an acidic vaginal environment (pH < 4.5).
- Step 2: A single oral dose of fluconazole (150 mg) or topical azole ovules/creams (e.g., clotrimazole) provides rapid and effective eradication.
Answer
Topical or oral antifungal therapy (e.g., oral fluconazole 150 mg single dose).
Why not the others: 'Oral metronidazole 500 mg twice daily for 7 days' is the treatment for bacterial vaginosis and trichomoniasis, and may precipitate candidiasis; 'Oral azithromycin 1 g single dose' treats Chlamydia; 'Intramuscular ceftriaxone 500 mg' treats gonorrhea.
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