Patient's question:
My leukorrhea is so much! There are four of them that have grown! There are also things like beans! It hurts during sexual intercourse! A bit itchy! It has a bad smell! Every time I have my period, the pain in my abdomen is unbearable! I have seen doctors several times, but none of them have been able to treat it! The doctors prescribed me! Ornidazole tablets. Leukorrhea treatment tablets. Itraconazole capsules. Baofukang suppositories. Daktarin. Almost every doctor prescribed almost the same medications! Just these few! The doctors all asked me to do a smear test! Every result has shown (yeast)! (Positive)!Doctor's answer:
Hello: According to your description, the diagnosis is candidal vulvovaginitis.Treatment:
a. Eliminate triggers
- If diabetes is present, provide active treatment; promptly discontinue broad-spectrum antibiotics and estrogens. Change underwear frequently. Wash used underwear, basins, and towels with boiling water.
b. Change the vaginal pH
- Use a 2%–4% sodium bicarbonate solution to rinse the vagina, creating conditions unfavorable for the survival of Candida.
c. Antifungal agents
- After rinsing with an alkaline solution, select the following medications:
c1: Clotrimazole (clotrimazole) suppositories or tablets, 1 dose per night, 1 suppository or tablet each time, inserted deep into the vagina, for 7 days.
c2: Miconazole nitrate (Daktarin) suppositories, 1 suppository per night inserted into the vagina, for 7 days.
c3: Nystatin suppositories or tablets, 1 dose per night, 1 suppository or tablet each time (100,000 U), for 7–10 days.
c4: Miconazole vaginal effervescent tablets, 1 tablet per night inserted into the vagina, for 5 days.
c5: 1% gentian violet solution for vaginal application, 3–4 times per week, for 2 weeks. The drug is inexpensive and highly effective, but the concentration must be carefully controlled. If the drug is too concentrated or used too frequently, it may cause chemical vulvitis and epidermal erosion. Due to its tendency to stain clothing, it is now rarely used in clinical practice.
d. Treatment for refractory cases
① This condition is often associated with diabetes. If it does not improve after prolonged treatment, check for urinary and blood sugar levels.
② It may also be concurrent with trichomoniasis, so check for trichomoniasis infection.
③ To prevent mutual infection of intestinal Candida, oral nystatin (500,000–1,000,000 U) can be administered every