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    smjpain posted:
    Hi Jane I wanted to show you my last weeks vaginal culture I have been on Diflucan since last week a total of 7. I went to my GYN in Mason today because I was itching so bad and swollen and a really bad odor. He is re-culturing and results wont be back till monday he wants me to take three more diflucan and also use micolog ointment 3x a day and call on monday it hurts so bad and also the smell is so powerful I can hardly stand it. What is going on with my vagina.
    YEAST CULTURE [a> [a class="contentlink">About This Test
    (Acct:N/A) (28 y.o. F) YEAST CULTUREResultsStatus:Final result 1/31/2013 11:38 AM For questions about test results after hours or on weekends and holidays, please contact UI Health Access at 1-800-777-8442, or 319-384-8442. Collection Information Specimen#Collection DateCollection TimeCollected BySpecimen SourceSpecimen Description MB13004083Jan 23, 201310:31 AM CST VAGINAL [270> Component Results FINAL REPORT: ---------------------- FINAL REPORT ----------------------
    01/31/2013 11:38 FEW CANDIDA (TORULOPSIS) GLABRATA (TORGLA) PRELIMINARY: ------------------- PRELIMINARY REPORT -------------------
    01/25/2013 07:54 FEW YEAST
    01/26/2013 14:20 FEW CANDIDA (TORULOPSIS) GLABRATA (TORGLA) POSITIVE MICRO TEST: Y Reviewed by List Bradley, Catherine S, MD on 1/31/2013 4:34 PM Elas, Diane, ARNP on 1/31/2013 11:50 AM Bradley, Catherine S, MD on 1/29/2013 9:05 AM Elas, Diane, ARNP on 1/28/2013 8:07 AM Bradley, Catherine S, MD on 1/25/2013 9:19 AM Bradley, Catherine S, MD on 1/24/2013 11:30 AM Elas, Diane, ARNP on 1/24/2013 11:24 AM [a class="button">Back to the Test Results List Home | Site Map | Terms & Conditions | Contact Us | FAQ | Log Out MyChart® licensed from Epic Systems Corporation, © 1999-2010. Patents pending.
    Jane Harrison Hohner, RN, RNP responded:
    Dear smjpain: My goodness, that's cool that you could cut and paste the lab report. What you have shared is a preliminary report on the culture. The technologist found small amounts of an atypical type of yeast ("candida glabrata"). This is not the usual candida albicans type of yeast for which most of our medications are effective. Here is a direct quote from an article targeted to healthcare providers about this organism (link to entire citation follows quote):

    Special situations involving antifungal resistance: Several of the Candida species require special mention because of their known intrinsic resistance to antifungals.

    Because C glabrata is known to be resistant to fluconazole in 15-25% of cases and has decreased susceptibility to most antifungals, C glabrata infections require a change in conventional antifungal therapy. The drugs of choice for such infections are the echinocandins: caspofungin 70 mg intravenously as a loading dose, followed by 50 mg/d; anidulafungin 200-mg loading dose, followed by 100 mg/d; or micafungin 100 mg/day intravenously. An alternative is voriconazole at 6 mg/kg administered twice on the first day, followed by 3 mg/kg twice per day or 200 mg twice per day orally; other options include amphotericin B deoxycholate (1 mg/kg/d), or lipid preparations of amphotericin B at 3-5 mg/kg/d.
    If in vitro susceptibility assays are available, it may be worthwhile to establish the in vitro susceptibility of the C glabrata strain to fluconazole. If the MIC is less than 8 3BCg/mL, then fluconazole can be used at 400 mg/d intravenously or orally.

    As you can note from the entire article smjpain, the medication regimen discussed above would be used with an immune compromised person who had systemic candida. Fortunately, yours seems to be localized to the genital tract. The very fact that the GYNs are doing cultures shows that they are taking your symptoms very seriously. When the final report on the culture is done, they will discuss treatment with you. You might be advised to use some uncommon treatments (eg gentian violet). You are seeing GYN's with high expertise in unusual vaginal/vulvar infections so I would urge you to go with their recommendations.

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