A 35 year old P3+0 woman reports severe itching in vagina. On examination you find a red swollen vulva, red vagina with thick curdy white discharge adherent to the vaginal walls. The diagnosis is:

Question

Question

This question was previously asked in

KGMU Nursing Officer 2023 Memory-Based Previous Year Paper

Answer 1

Correct Answer: Candida vaginitis

Rationale:

Candida vaginitis is a fungal infection caused by Candida species, most commonly Candida albicans. It is one of the most common causes of vaginal itching and discharge.
The clinical presentation described in the question aligns with Candida vaginitis, which typically includes severe itching, redness, swelling of the vulva, and a thick, curdy white discharge adhering to the vaginal walls.
Candida thrives in warm and moist environments and can be triggered by factors such as pregnancy, diabetes, antibiotic use, immunosuppression, or hormonal changes.

Key Points Related to Candida Vaginitis:

Symptoms: Intense vaginal itching, burning sensation, thick white discharge with a cottage cheese-like texture, and erythema (redness) of the vulva and vagina.
Diagnosis: Clinical observation combined with laboratory tests such as wet mount microscopy, where budding yeast or pseudohyphae can be identified, or fungal culture for confirmation.
Treatment: Antifungal medications such as fluconazole (oral) or clotrimazole/miconazole (topical) are commonly used.
Prevention: Maintaining good hygiene, avoiding tight clothing, managing underlying conditions like diabetes, and limiting unnecessary antibiotic use.

Explanation of Other Options:

Trichomonal vaginitis

Rationale: Trichomonal vaginitis is caused by the protozoan Trichomonas vaginalis. Symptoms typically include frothy, yellow-green vaginal discharge with a foul odor, itching, and strawberry cervix (petechiae on the cervix). The description provided in the question does not match these clinical features.

Tubercular vaginitis

Rationale: Tubercular vaginitis is a rare condition caused by Mycobacterium tuberculosis. It often presents with nonspecific symptoms like pelvic pain, irregular menstrual cycles, and discharge. It is not associated with thick curdy white discharge or severe itching, making this option incorrect.

Chlamydia vaginitis

Rationale: Chlamydia-related infections typically involve the cervix (cervicitis) rather than causing vaginitis. Symptoms may include mucopurulent cervical discharge, pelvic pain, and intermenstrual bleeding. It does not present with curdy white discharge or red swollen vulva as described in the question.

Conclusion:

The clinical features provided, including severe vaginal itching, red swollen vulva, and thick curdy white discharge adhering to the vaginal walls, strongly suggest Candida vaginitis. Other options do not align with the described symptoms and presentation.