Abdoulie Gassama

EN, RN, BSN, MSN

 OUTLINE
• Introduction
• Pathophysiology
• Predisposing factors
• Classification
• Diagnosis
• Medical & Nursing Management
• Prevention
 INTRODUCTION
• The vagina is a dynamic ecosystem that
normally contains approximately 109
bacterial colony-forming units per gram
of vaginal fluid.
• The normal vaginal discharge is clear to
white, odorless, and of high viscosity.
• Many different bacteria usually inhabit the
vagina. E.g. Lactobacilli
 INTRODUCTION CONT..
• Lactobacilli excrete hydrogen peroxide
creating an acidic (low-pH) environment,
which is a natural disinfectant that acts to
maintain the normal balance of organisms in
the vagina that is hostile to disease bacteria.
• Any condition that changes the vaginal
acidity or disturb the normal bacteria may
predispose to an infection.
• There is a delicate balance between the two major microorganisms
normally found in the vagina of women during their reproductive
years. These microorganisms are Candida (a type of yeast or fungus)
and Lactobacillus sp Lactobacillus sp.(a bacteria)
 PATHOPHYSIOLOGY
• Vaginal candidiasis (moniliasis)-
opportunistic fungal infection which is
caused by C. albicans (common).
• Candida species are normal flora of the
skin and the vagina and are not
considered as sexually transmitted
pathogens.
• Disruption in the host vaginal
environment, however, can
cause Candida organisms to transition
from a commensurate to pathologic role.
 PREDISPOSING FACTORS
• Antibiotics and corticosteroids kill the
vaginal normal bacteria that maintain
acidity;
• Menstruation where blood alkalinity
increases the vaginal PH
• Sexual intercourse through sperms’
alkalinity increase the vaginal PH;
• Tight synthetic clothing creates a moist,
warm environment for Candida
proliferation
 PREDISPOSING FACTORS CONT..
• Perfumed soaps
• Bubble baths and oils causes skin
irritation making thrush possible
• diabetes young or old age and
malnutrition
• AIDS
• Poor personal hygiene,
 CLASSIFICATION
• Taking into account factors specific to
the host and pathogen, vaginal
candidiasis is classified as:
• Uncomplicated vaginal candidiasis:
defined as infection in an
immunocompetent, nonpregnant woman
that is mild-to-moderate in severity, recurs
less than four times per year, and
involves Candida albicans strains that
respond to all forms of antifungal therapy.
 CLASSIFICATION CONT…
• Complicated vaginal candidiasis, by
contrast, is defined as infection that is
(1) moderate to severe, (2) associated
with pregnancy or other concomitant
conditions (i.e. immunosuppression,
diabetes mellitus), or (3) recurs more
than four times per year in
immunocompetent women.
• Among women with HIV infection, vulvovaginal candidiasis occurs
more frequently than in women without HIV infection.[ With more
advanced HIV disease, vulvovaginal candidiasis often is more severe
and may recur more frequently
 CLINICAL MANIFESTATION
• Vaginal candidiasis classically presents with
symptoms such as pruritus (the most common
symptom)
• vaginal soreness
• Dyspareunia
• External dysuria
• Abnormal vaginal discharge
• Foul smell
• Vaginal and mouth thrush etc.
 DIAGNOSIS
• Urinalysis – examine the deposit
microscopically for budding yeast
cells
• Potassium Hydroxide (KOH) and
Saline Wet Mount Preparation and
Microscopy
• Gram stain
• Culture
 MEDICAL MANAGEMENT
• The guidelines recommend a variety of
short-course intravaginal antifungal
agents to treat uncomplicated vaginal
candidiasis.
• Many of the treatment options are
available in over-the-counter
formulations.
• The recommendations include one
option for patients who prefer oral
therapy:
 MEDICAL MANAGEMENT CONT…
• Fluconazole 150 mg orally in a single dose.
• The short-course topical formulations are
effective in treating uncomplicated vaginal
candidiasis and azole drugs are more
effective than topical nystatin.
• An estimated 80 to 90% of patients with
vaginal candidiasis who complete treatment
with an azole have a relief in symptoms and
negative cultures.
• E.g. Clotrimazole cream
 MEDICAL MANAGEMENT CONT…
• Treatment of Recurrent vaginal
Candidiasis
• For patients who develop recurrent
vaginal candidiasis (four or more
episodes within 1 year)
• Treatment guidelines recommend a
strategy of using a longer 7 to 14 day
initial course of therapy to achieve clinical
remission, followed by a 6-month
maintenance regimen.
 MEDICAL MANAGEMENT CONT..
• The longer course initial therapy options include topical
therapy for 7 to 14 days or oral fluconazole given as a
100 mg, 150 mg, or 200 mg oral dose every third day
(day 1, 4, and 7) for a total of 3 doses
• The preferred maintenance therapy consists of
oral fluconazole (100, 150, or 200 mg) given weekly
for 6 months; maintenance therapy has been
demonstrated to reduce episodes of vulvovaginal
candidiasis, but symptoms recur in about 30 to 50% of
women once maintenance therapy is stopped.
• For patients who cannot take
oral fluconazole maintenance therapy, topical azole
therapy given intermittently can be used as an
alternative.
 MANAGEMENT OF SEX
PARTNERS
• vaginal candidiasis is not sexually transmitted
so there is no treatment necessary for
asymptomatic sex partners of infected women.
• Balanitis caused by Candida species is an
uncommon finding in men and may be due to
risk factors other than penile-vaginal sex,
including age over 40, diabetes mellitus, or
uncircumcised status.
• Men with candidal balanitis should be treated
with 1 to 2 weeks of topical antifungal therapy,
or one day of oral antifungal therapy
 NURSING MANAGMENT
• NURSING DIAGNOSIS
• Discomfort related to burning, odor, or
itching from the in-fectious process
• Anxiety related to stressful symptoms
• Risk for infection or spread of infection
• Deficient knowledge about proper
hygiene and preventive measures
• PLAN/GOAL:
• The major goals for the patient may include:
• relief of discomfort
• reduction of anxiety related to stress
symptoms
• prevention of re-infection or infection of
sexual partner
• and acquisition of knowledge about methods
for preventing vaginal infections and
managing self-car
• NURSING INTERVENTION
• Treatment with the appropriate medication usually
relieves dis-comfort.
• Sitz baths are occasionally recommended. Use of
corn-starch powder may relieve discomfort and
skin irritation.
• Explaining the cause of symptoms to reduce
anxiety related to fear of a more serious illness.
• Discus ways to help prevent vaginal infections to
help the patient adopt specific strategies to
decrease infection and the related symptoms
 PREVENTION
• Avoid douching.
• Avoid unnecessary antibiotic use.
• Avoid repeated courses of self-administered,
over-the-counter antifungal therapy in
settings where no laboratory diagnosis has
been confirmed.
• Complete the full course of any prescribed
therapy.
• Optimize the management of other
concurrent illnesses, such as diabetes
mellitus and HIV infection.
 CASE STUDY
• Fatoumatta Darboe, a 32 -year-old female presents with a 2-day history of
dysuria, vaginal itching, and pain during sexual intercourse. She denies
fever, chills, or pelvic pain. She is sexually active with several partners and
uses condoms consistently. She reports one prior episode of similar
symptoms earlier this year, which resolved with the use of an over-the-
counter topical anti-fungal cream. She denies other underlying medical
conditions and she does not take any medications. On physical
examination of the external genitalia, there is significant vulvar edema
and pelvic examination reveals thick, white vaginal discharge.

• What is the diagnosis for Fatoumatta?

• What is the causative organism for Fatoumatta’s condition?

• How will you confirm Fatoumatta’s diagnosis?

• What is the medical management for Fatoumatta?

• With the use of a Nursing care plan, state the nursing management for
Fatoumatta?