Illness script
Vulvovaginal Candidiasis
Reproductive-age woman with intense vulvar itching and thick white 'cottage cheese' discharge.
This illness script for Vulvovaginal Candidiasis covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Reproductive-age women; up to 75% have ≥1 lifetime episode
- Recent antibiotic use disrupting normal flora
- Diabetes (especially uncontrolled), immunosuppression, HIV
- Pregnancy and high-estrogen states
- Candida albicans most common species
02
Diagnostics & workup
- Vulvar/vaginal pruritus, burning, dyspareunia, external dysuria
- Thick, white, clumpy 'cottage cheese' discharge; vulvar erythema/edema
- Normal vaginal pH (<4.5) — key distinguishing feature
- KOH wet mount: budding yeast and pseudohyphae
- No fishy amine odor (negative whiff test)
- Culture for recurrent or refractory cases
03
Pathophysiology
- Overgrowth of commensal Candida (usually C. albicans) in vagina
- Disruption of normal lactobacilli-dominant flora
- Estrogen promotes vaginal glycogen favoring yeast growth
- Immune/inflammatory response drives itching and erythema
04
Treatment
- Uncomplicated: single-dose oral fluconazole 150 mg
- Alternative: topical azoles (clotrimazole, miconazole) 1–7 days
- Pregnancy: topical azoles only (avoid oral fluconazole)
- Recurrent (≥4/yr): fluconazole 150 mg q72h x3, then weekly x6 months
- Complicated/severe: extended azole course; consider culture for non-albicans
- No treatment of asymptomatic partners needed
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Full libraryEducational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.