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A 23-year-old woman is evaluated for a 2-week history of persistent thick, white vaginal discharge; burning in the vulvar and vaginal regions; and vaginal itching. She has never had these symptoms before and is in a monogamous sexual relationship. Her medical history is otherwise unremarkable, and she takes no medications.

On physical examination, vital signs are normal. Pelvic examination reveals vulvar edema with a few excoriations. Speculum examination demonstrates thick, white, curdy vaginal discharge. The remainder of the examination is unremarkable.

Laboratory studies reveal:
- Vaginal pH: 4.4
- Whiff test result: negative
- Potassium hydroxide microscopy shows hyphae
- Tests for Chlamydia trachomatis and Neisseria gonorrhoeae: negative

Which of the following is the most appropriate treatment?

A. Intravaginal clotrimazole
B. Intravaginal nystatin
C. Oral metronidazole
D. Oral voriconazole

Answer :

Final answer:

The most appropriate treatment for the woman's vaginal candidiasis is intravaginal clotrimazole, which is an effective topical antifungal against Candida albicans.

Explanation:

The most appropriate treatment for the 23-year-old woman with a history of persistent, thick, white vaginal discharge and laboratory findings indicative of vaginal candidiasis (presence of hyphae and low vaginal pH) is intravaginal clotrimazole. This medication is a topical antifungal that is effective against Candida albicans, the yeast causing her symptoms. Since the whiff test was negative, treatment for bacterial vaginosis with oral metronidazole would not be appropriate. Neither oral voriconazole (an antifungal for systemic or severe fungal infections) nor intravaginal nystatin (another antifungal), though potentially effective against candidiasis, are indicated as first-line treatments over clotrimazole in this case.

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