For my Family Medicine rotation, I had the opportunity of presenting my patient cases to Dr. Beckerman. Out of the 2 cases I presented, I found the case of the woman with vaginal and itching and burning the most interesting. She was a 23 year old female with no significant medical history who presented to the office with vaginal itching and burning for 1 week. She had previously been seen and treated for amenorrhea and was on norethindrone acetate, but the patient had discontinued it as she thought her symptoms were due to the medication. The patient had not tried any OTC medications. She denied any changes in sexual partners, fishy odor, recent antibiotic use, hematuria, flank pain, abdominal pain, fever, chills, nausea, vomiting, diarrhea, SOB or chest pain. 

My initial differential diagnoses based on this history were Candida vulvovaginitis, cystitis, STI, and nephrolithiasis.

On exam, the patient’s vitals were stable, and patient was afebrile. The exam was only significant for white discharge.

The only lab ordered at this visit time was a urine dipstick which showed glucose of 150, which prompted further investigation. At the prior office visit, the patient had labs drawn that had not been reviewed with the patient yet, so we looked for abnormalities among those labs. The labs were significant for an A1c of 9.8, Glucose of 211, Cholesterol of 227, LDL of 113, HDL of 37, and Triglycerides of 385. 

Based on the physical exam findings and labs, my leading differential was Candida vulvovagintits secondary to uncontrolled diabetes; however, further evaluation was needed to determine whether the patient had type 1 or type 2 diabetes. The patient had a strong family history of type 2 diabetes. 

After receiving feedback from my site evaluator, it was discussed to include whether or not the patient had any changes in products or using vaginal washes that could be causing her irritation.