Home' Australian Pharmacist : Australian Pharmacist Sept 2013 Contents 50
Australian Pharmacist September 2013 I ©Pharmaceutical Society of Australia Ltd.
COUNSELLING IN PRACTICE
1. Which of the following statements
regarding the aetiology of vaginal
thrush (vulvovaginal candidiasis;
VVC) is CORRECT?
a) Several species of Candida colonise
the vaginal tract, but only C. albicans
b) The inflammation in VVC is thought
to occur as a result of the migration of
neutrophils into the vagina.
c) Post-menopausal women have a
higher risk of developing VVC than
women of child-bearing age.
d) Oestrogen reduces the ability of C.
albicans to adhere to the vaginal
2. Which of the following is LEAST
likely to be a risk factor for VVC?
a) Use of high-oestrogen oral
b) Poorly controlled diabetes.
c) Vaginal colonisation with lactobacilli.
d) Infrequent sexual intercourse.
3. The typical symptoms of VVC
a) A thin, white/grey vaginal discharge
with an offensive odour.
b) A yellow/green frothy vaginal
discharge with a fishy odour.
c) A thick, white, curd-like vaginal
d) A bloody vaginal discharge.
4. Which of the following would be
the most appropriate treatment
regimen for a pregnant woman with
a) Miconazole 2% vaginal cream, 1
applicatorful intravaginally once daily
for 7 days.
b) Nystatin vaginal cream, 1 applicatorful
intravaginally once daily for 14 days.
c) Butoconazole 2% vaginal cream, 1
applicatorful intravaginally as a single
dose at bedtime.
d) Fluconazole 150 mg, one capsule as a
single oral dose.
5. Which of the following is an
appropriate point to consider
when deciding on treatment to
recommend for a woman with VVC?
a) In uncomplicated VVC, a single oral
dose of fluconazole is generally more
effective than a topical azole.
b) Topical nystatin has the same efficacy
as topical azoles, but causes more local
c) A single high dose of a topical azole is
as effective as multiple smaller doses
given over several days.
d) An azole cream can also be used by the
woman’s partner, as sexual partners of
women with VVC should be routinely
1. Harris P, ed. Mosby’s dictionary of medicine, nursing & health
professions. 2nd Australian & New Zealand ed. Elsevier
2. Oakley A. Vulvovaginal candidiasis [last updated Jan 2012].
DermNet NZ. At: http://dermnetnz.org/fungal/vaginal-
3. Sheary B, Dayan L. Recurrent vulvovaginal candidiasis. Aust
Fam Phys March 2005;34(3):147–50. At: http://www.racgp.org.
4. Wolff K, Johnson R, Suurmond D. Fitzpatrick’s Color Atlas and
Synopsis of Clinical Dermatology, 5th ed. McGraw-Hill 2005.
5. Pray W Steven. Nonprescription product therapeutics, 2nd edn.
Lippincott Williams & Wilkins, 2006.
6. Achkar JM, Fries BC. Candida infections of the genitourinary
tract. Clin Microbiol Rev. 2010;23(2):253–73. At: http://cmr.asm.
7. Fidel PL Jr, Barousse M, Espinosa, T et al. An intravaginal live
Candida challenge in humans leads to new hypotheses for
the immunopathogenesis of vulvovaginal candidiasis. Infect
Immun. 2004 May;72(5):2939–46. At: http://www.ncbi.nlm.nih.
Key learning points
Vaginal thrush (vulvovaginal
candidiasis; VVC) is an infection caused
by species of Candida, a genus of
yeast-like fungi. The causative agent
in over 80% of VVC infections is
C. albicans. Factors that increase the risk
of VVC include use of high-oestrogen
oral contraceptives, broad-spectrum
antibiotics or corticosteroids,
pregnancy, poorly controlled diabetes,
obesity, iron deficiency anaemia and
Symptoms of VVC include a thick, white,
curd-like vaginal discharge, localised
itching, burning and irritation, dysuria,
dyspareunia and a vulval rash. Because
the symptoms are non-specific, other
possible causes (e.g. trichomoniasis,
bacterial vaginosis, pelvic inflammatory
disease) need to be ruled out before
treatment is recommended. Recurrent
VVC (RVVC) is defined as ≥4 episodes
in a year.
Most cases of VVC can be treated
effectively with an azole (butoconazole,
clotrimazole, miconazole) vaginal
cream or pessaries, or nystatin vaginal
cream. Women who would prefer to
use oral therapy can take a single oral
dose of fluconazole 150 mg. Women
with RVVC may require long-term
topical or oral antifungal therapy.
A counselling guide for vaginal
thrush and a guidance document
for provision of fluconazole as a
Pharmacist Only medicine can be
found in the APF22.
8. Scott McClelland R, Richardson BA, Hassan WM, et al.
Prospective study of vaginal bacterial flora and other
risk factors for vulvovaginal candidiasis. J. Infect. Dis.
2009;199(12):1883–90 . At: http://jid.oxfordjournals.org/
9. Zhou X, Westman R, Hickey R. et al. Vaginal microbiota of
women with frequent vulvovaginal candidiasis. Infect Immun.
2009 Sep;77(9):4130–35. At: www.ncbi.nlm.nih.gov/pmc/
10. Oakley A. Vaginitis [updated Dec 2012]. DermNet NZ. At: http://
11. Oakley A. Cytolytic vaginosis [updated Jan 2012]. DermNet NZ.
12. Suresh A, Rajesh A, Bhat RM, Rai Y. Cytolytic vaginosis: A review.
Indian J Sex Transm Dis. 2009 Jan-Jun;30(1):48–50. At: www.
13. Rossi S, ed. Australian Medicines Handbook 2013 [online].
Adelaide: Australian Medicines Handbook; 2013 Jan.
14. Vulvovaginal candidiasis [revised Feb 2009]. In: eTG complete.
Melbourne: Therapeutic Guidelines; 2012.
15. Faculty of Family Planning and Reproductive Health Care
Clinical Effectiveness Unit. FFPHRC and BASHH Guidance
(Jan 2006). The management of women of reproductive age
attending non-genitourinary medicine settings complaining
of vaginal discharge. J. Family Planning and Reproductive
Health Care. 2006;32(1):33–42. At: http://jfprhc.bmj.com/
16. Diflucan One product information. eMIMs. St Leonards: UBM
Medica Australia, 2012 Apr.
17. Sansom LN, ed. Australian pharmaceutical formulary and
handbook. 22nd edn. Canberra: Pharmaceutical Society of
18. Better Health Channel. Vaginal thrush [revised Oct 2011]. At:
19. Young G, Jewell D. Topical treatment for vaginal candidiasis
(thrush) in pregnancy. Cochrane Database of Systematic
Reviews 2001, Issue 4. At: http://onlinelibrary.wiley.com/
20. Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention
of recurrent vulvovaginal candidiasis: a review. J Antimicrobial
Chemotherapy. 2006;58(2):266–72. At: http://jac.oxfordjournals.
21. Royal Women’s Hospital Pharmacy Department. Pregnancy
and breastfeeding medicines guide. Melbourne: Royal
Women’s Hospital, 2010.
Links Archive Australian Pharmacist August 2013 Australian Pharmacist Oct 2013 Navigation Previous Page Next Page