A 35-year-old immunocompetent woman presents with white, thick, discharge per vagina with vulval itching. KOH mount shows pseudohyphae and budding yeast cells. The drug of choice for recurrent vulvovaginal candidiasis (RVVC, ≥4 episodes/year) is:
- A Nystatin vaginal pessary daily for 14 days
- B Topical clotrimazole 1% cream twice daily for 7 days
- C Oral fluconazole 150 mg weekly for 6 months as maintenance therapy ✓
- D Oral itraconazole 200 mg BD for 3 days each month
Correct answer: C. Oral fluconazole 150 mg weekly for 6 months as maintenance therapy
Explanation
RVVC (≥4 episodes in 12 months) requires an induction followed by maintenance phase. Current CDC and ISSVD guidelines recommend fluconazole 150 mg orally every 72 hours for 3 doses as induction, then fluconazole 150 mg weekly for 6 months as maintenance. This reduces recurrence frequency significantly. Non-albicans Candida (C. glabrata, C. krusei) should be suspected if fluconazole fails — boric acid vaginal suppositories or nystatin are alternatives. Nystatin has poor systemic absorption and is not effective for maintenance.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.