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Recurrent vulvovaginal candidiasis (yeast infection) is a debilitating, long-term condition that can severely affect the quality of life of affected women (Denning et al., 2018). The onset of most yeast infection cases is believed to be associated with a wide range of predisposing factors or triggering events, including the use of antibiotics, increased estrogen levels (e.g., high estrogen oral contraceptives, hormone replacement therapies, pregnancy), sexual activities, tight-fit clothing, and diabetes mellitus, which is an endocrine disorder (Yano, 2019).

Additional subjective Information are as follows:

When did the symptom first start?

You stated there is a recurring yeast infection; when was the last time you had the yeast infection?

What type of treatment did you receive for your last yeast infection?

Do you have any additional symptoms, such as burning, itching, or redness?

Do you experience any frequency or urgency to void?

Do you notice any vaginal discharge or odor?

What type of undergarments do you mostly wear? Such as cotton or silk.

Do you douche? If yes, how often?

Do you use fragrance soap, powder, or spray on your perineum area?

Have you taken any antibiotics recently?

Are you taking contraceptives?

Are you sexually active?

Are you taking any type of hormone products?

How much fluid do you drink daily?

What type of fluid do you drink the most? Such as water, soda, tea, or any other types of beverages?

Have you ever had a Hemoglobin A1C blood test done?

Do you notice any changes in your diet or eating habits?

Do you notice any unexpected weight gain or loss?

Do you have any family history of endocrine disorders? Such as Diabetes, or thyroid problem?


Yano, J., Sobel, J.D., Nyirjesy, P. et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management, and post-treatment outcomes. BMC Women’s Health 19, 48 (2019). to an external site.

Denning, D. W., Kneale, M., Sobel, J. D., & Rautemaa-Richardson, R. (2018). Global burden of recurrent vulvovaginal candidiasis: A systematic review. The Lancet Infectious Diseases, 18(11). 

Critical Thinking Question # 3

What is your working diagnosis and appropriate differential diagnoses (DDx) list (include three DDx)?

Critical Thinking Question # 4
What is your treatment plan for this patient including education, counseling, & health promotion/disease prevention? 

Expert Solution Preview

Recurrent vulvovaginal candidiasis, commonly known as yeast infection, is a chronic condition that significantly impacts the quality of life for affected women. Various factors can contribute to the occurrence of yeast infection, such as the use of antibiotics, hormonal changes, sexual activities, tight-fit clothing, and diabetes. This post provides additional subjective information to further assess the patient’s condition and develop an accurate diagnosis, treatment plan, and health promotion strategies.

Answer to Critical Thinking Question #3:
Based on the information provided, the working diagnosis for this patient is recurrent vulvovaginal candidiasis, also known as a yeast infection. However, it is crucial to consider appropriate differential diagnoses to ensure a comprehensive evaluation. Three potential differential diagnoses for this patient may include:

1. Bacterial Vaginosis: This condition occurs due to an imbalance of bacteria in the vagina, leading to symptoms like vaginal discharge, odor, and itching. It is essential to rule out bacterial vaginosis as it shares similar symptoms with yeast infection.

2. Trichomoniasis: This sexually transmitted infection can cause symptoms like itching, burning, and vaginal discharge. It is important to consider trichomoniasis as a potential differential diagnosis given the patient’s sexual activity.

3. Allergic Reaction: Sometimes, allergic reactions to certain products, such as soaps, powders, or sprays, may lead to symptoms similar to yeast infection. Assessing the patient’s exposure to potential allergens is necessary to eliminate this differential diagnosis.

By considering these potential differential diagnoses, healthcare providers can ensure a more accurate diagnosis and appropriate treatment plan.

Answer to Critical Thinking Question #4:
The treatment plan for this patient with recurrent vulvovaginal candidiasis should include not only medical interventions but also education, counseling, and health promotion/disease prevention strategies. The following elements should be included in the treatment plan:

1. Antifungal Medications: Prescribe appropriate antifungal medications, such as topical or oral antifungal agents, to eradicate the yeast infection and provide relief from symptoms. Educate the patient about the proper use, dosage, and potential side effects of these medications.

2. Patient Education: Provide comprehensive education regarding yeast infections, including causes, risk factors, prevention strategies, and self-care measures. Emphasize the importance of maintaining good hygiene, avoiding irritants, and practicing safe sexual activities.

3. Lifestyle Modifications: Encourage the patient to make necessary lifestyle changes to reduce the risk of recurrent infections. This may include wearing breathable cotton underwear, avoiding tight-fit clothing, and maintaining a healthy diet.

4. Counseling and Emotional Support: Address any emotional or psychological concerns related to recurrent infections. Offer counseling and support services to help the patient cope with the distressing impact of the condition on their quality of life.

5. Health Promotion and Disease Prevention: Emphasize the significance of regular gynecological exams, routine screening for sexually transmitted infections, and maintaining a healthy lifestyle to prevent recurrent vulvovaginal candidiasis and other reproductive health issues.

By implementing this comprehensive treatment plan, healthcare providers can not only manage the current yeast infection but also empower the patient to take control of their own health and prevent future occurrences.

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