A 24-year-old female patient presents at the healthcare provider’s office with the primary report of itching and burning in the vaginal area.
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History and Physical
A 24-year-old female patient presents at the healthcare provider’s office with the primary report of itching and burning in the vaginal area. The patient shares that she has had a thick, white vaginal discharge for the past 4 days. The patient also claims to have had a sinus infection a week ago and to have just finished an antibiotic. The sinus infection has resolved. The patient has only had one sexual partner and takes oral contraceptives.
Upon examination, the healthcare provider notices that the vagina and vulva areas are red, with a cottage-cheese–like, odorless discharge.
Nurses’ Notes
1035: Patient presents with report of itching and burning in the vaginal area. In addition, she shares that she has had a thick, white vaginal discharge.
1050: Healthcare provider orders fluconazole.
Orders
1050
Fluconazole 150 mg orally one-time dose
So close!
Rationale:
Potential Conditions
Vaginal candidiasis (yeast infection) presents with itching, burning, or irritation, along with a white, odorless, cottage-cheese–like discharge from the vagina. Trichomoniasis, bacterial vaginosis, or chlamydia do not present with a thick, white, cottage-cheese–like discharge.
Actions to Take
Fluconazole is an antifungal medication that is often used to treat vaginal candidiasis. Precautions should be taken when administering fluconazole to those pregnant or breastfeeding. In addition, fluconazole is not recommended for people who are hypersensitive to any of the antifungal azole drugs. An ECG or a vaginal culture is not needed before treating vaginal candidiasis with fluconazole. Oral contraceptives do not interact or interfere with fluconazole.
Patient Education
Patients should be advised to take fluconazole with food to avoid gastrointestinal issues. Hepatotoxicity is an adverse reaction to fluconazole, and patients should learn to recognize symptoms of hepatotoxicity. Oral contraceptives do not interact with fluconazole so the patient should not be advised to refrain from using birth control for 7 days. There is no need to avoid citrus foods or acetaminophen while taking fluconazole. Blood pressure does not need to be monitored while taking fluconazole.
