Case Scenario: Vaginal Candidiasis

Summary:

This case involves a patient presenting with symptoms indicative of vaginal candidiasis, including white, cottage cheese-like vaginal discharge. The discussion focuses on appropriate history-taking, diagnostic approach, risk factor identification, patient education, and management.

Key Points:

History Taking and Diagnostic Approach

• Focused questioning: Open-ended questions help patients describe their symptoms accurately.

• Avoid unnecessary tests: Routine blood tests for hypertension are not needed unless justified.

• Essential investigations:

  • Urine Pregnancy Test (UPT): Mandatory for women of reproductive age.

  • Diabetes screening: If risk factors for diabetes are present, a blood glucose test can be considered.

  • Sexual health history: Important but should be balanced with other risk factors.

Risk Factors for Candidiasis

• Immunocompromised states: Diabetes mellitus weakens the immune system, increasing susceptibility to infections.

• Hygiene practices:

  • Frequent douching

  • Use of scented hygiene products

  • Long bubble baths

• Antibiotic use: Can disrupt normal vaginal flora.

• Tight or synthetic clothing: Creates a moist environment conducive to fungal growth.

Management Plan

• First-line treatment:

  • Topical antifungal (Clotrimazole cream) for local relief.

  • Oral Fluconazole for systemic treatment, especially for recurrent infections.

  • Antihistamines can help with itching (ensure to mention this explicitly for exam scoring).

• Preventive advice:

  • Encourage showers instead of long bubble baths.

  • Avoid irritating hygiene products.

  • Recommend cotton underwear and avoid tight-fitting clothing.

• Patient education: Explain that yeast infections are common and often recur if risk factors persist.

Communication Skills

• Clarity in explanations:

  • Instead of just "yeast infection," clarify that it is a fungal infection and thus treated with antifungal medications.

• Checking patient’s understanding:

  • If the patient is aware of candidiasis, ask, "Would you like me to explain further?"

• ICE (Ideas, Concerns, Expectations):

  • Idea: Ask what the patient thinks is causing the symptoms.

  • Concern: Address misconceptions, e.g., fear of cancer.

  • Expectation: Ensure the patient understands the treatment plan and preventative measures.

Ethical Considerations

• Cervical screening: If the patient expresses concern about cancer, inquire about her last Pap smear (routine screening in the UK from age 24).

• Confidentiality: Avoid unnecessary stock phrases; instead, focus on patient engagement​.

• Avoid over-investigating: Ordering unnecessary tests burdens the healthcare system​.

Additional Resources

• NICE guidelines on vaginal candidiasis

• GMC Good Medical Practice on effective patient communication​

• PLAB 2 Examiner Tips: Focus on structured, relevant history-taking and avoid rehearsed consultations​.