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The history should include:
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nature of discharge: colour, odour, quantity, relation to menstrual cycle, associated symptoms (e.g. dyspareunia)
irritation or itch and location
sexual history: STI risk factors, previous STIs
use of chemicals, such as soaps, deodorants, pessaries and douches
pregnancy possibility
drug therapy
associated medical conditions (e.g. diabetes)
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Inspection with good light includes viewing the vulva, introitus, urethra, vagina and cervix
Look for the discharge and specific problems such as polyps, warts, prolapses and fistulas
Consider bimanual pelvic examination
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High vaginal swab for microscopy and culture
pH test with paper of range 4–7
Amine or ‘whiff’ test
Wet film microscopy of a drop of vaginal secretions (if microscope available)
Vaginal swab for STIs: chlamydia, gonorrhoea, mycoplasma (consider trichomonas, HSV)
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Vaginal thrush (candidal vulvovaginitis)
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Limit washing to once/day with water or a pH adjusted wash for sensitive skin
Dry area thoroughly
Wear loose-fitting cotton underwear
Avoid wearing tight clothing
Avoid vaginal douches, powders or deodorants
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Can use an azole (clotrimazole, isoconazole, butoconazole, miconazole, ketoconazole or fluconazole) for 1–7 days, depending on strength.
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first line: clotrimazole 1%, 2% or 10% vaginal cream, 1 applicator-full intravaginally, nocte for 6 d if 1%, 3 d if 2% or once only if 10%
if recalcitrant: nystatin vaginal cream, 1 applicator-full, nocte for 14 d
fluconazole 150 mg (o) as a single dose if topical therapy not tolerated or oral therapy preferred
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For patients with chronic vulvovaginal candidiasis, use fluconazole 50 mg (o) or itraconazole 100 mg (o) daily until remission achieved and ...