Anastasia Petrenko

Age: 11-year-old female

Full Case

Patient's Data

Patient’s Name: Anastasia Petrenko

Age: 11-year-old female

Past Medical History

  • Nil

Drug History

  • Nil

Alerts and QOFs

  • Patient is up to date with her immunizations

Recent notes / Consultation

Seen by Dr. Sarah Patel (Clinical practitioner role) 8 months ago

Patient was seen with mum. Patient reported vulval/vaginal itching with burning sensation when she pees ongoing for 4days.

On examination: Vitals are stable. External inspection of vulval area with consent from mum and patient- vulval rednessand little whitish discharge noted, no evidence of ulceration.

Urinalysis; Leucocytes 1+, negative nitrates

Impression: Vulvovaginal candidiasis, r/o UTI

Plan: Send urine for culture, treat for thrush (Candida) withtopical clotrimazole 1% cream applied 2–3 times a day to theanogenital area affected for 7 days. Worsening advice given.

Telephone consultation with Dr. Emily Robertson 3 months ago

Mum called, reports that patient has symptoms of vaginal itching and redness down below. No urinary symptoms. She says symptoms are similar to what she had 5 months ago and requesting to be prescribed clotrimazole cream as it helped.

Plan: Topical clotrimazole 2% cream TDS for 7 days prescribed;no examination performed. Worsening advice given Grand-Mum (Katerina Kovalenko) on call to discuss concerns.

Urine Culture Microscopy

Urine culture

Microscopy:

  • White Blood Cells (WBC): <5 /hpf (Normal)
  • Red Blood Cells (RBC): None detected
  • Epithelial Cells: Occasional

Culture:

  • Growth: No growth observed at 24 and 48 hours of incubation.

Sensitivity Testing: Not applicable (No organisms isolated).

Patient's Story (Role Play)

You are Katerina Kovalenko-the Grand mum of Anastasia Petrenko. You are the mother of Anastasia’s Mum. The Mum has gone to work and has asked you to ring the GP onbehalf of Anastasia.

Anastasia has developed another episode of vaginal itching and soreness when she pees for the last 4 days. She has also mentioned a whitish discharge. She is peeing normally and passing stool normally She is otherwise well.

You booked this appointment to get a prescription of a cream called Canesten 2% which she used the last time that helped with her symptoms.

ONLY SAY THIS IF ASKED – You and her mum have been using and advising her to use soap to wash down below properly, so you do not know why she still keeps getting this infection. This was started after the first episode

Social history: Anastasia lives with the mum and dad. She has no other sibling and no one else lives at home. You do not suspect any form of abuse.

She is doing well at school and you pick her up every day from school. She is currently in school now.

Ideas: You suspect is the thrush.

Concerns: You are worried that she is too young to be having thrush and you would like to know what to do to prevent it.

Expectations: You would like Canesten cream.

SAY NO TO ANY OTHER QUESTIONS ASKED

Marking Scheme

History

  • Ask about current symptoms onset
  • Ask how may episode she’s had so far in the last 1 year (Recurrent candida is 4 or more episodes of candida infection per year)
  • Ask about vaginal itching, redness, discharge etc.
  • Ask about urinary symptoms including frequency, dysuria, blood in urine etc
  • Ask/Explore hygiene practices; such as douching with water or local irritants such    as soaps, shampoos, shower gels etc.
  • Ask about diabetes as this can cause recurrent candida infection- peeing excessively, drinking excessively, weight loss or weight gain
  • Ask about systemic symptoms- fever, abdominal pain
  • Ask if there is any history of inappropriate contact or sexual abuse – ask if there is any change in her behaviour ( is she withdrawn or not wanting to socialize?)
  • Ask about home situation –who lives at home and ask about school
  • Ask about her general health including her diet
  • Ask Grand mum’s ICE
  • Give a diagnosis of likely vulvovaginal candidiasis and explain to patient’s Grand-Mother Mrs. Kovalenko (or Just Katerina if she prefers this), thank you for sharing all the details about Anastasia’s symptoms.

From everything you’ve described, it does sound like she may be having another episode of vaginal thrush. While thrush isn’t very common in girls her age,  it can happen, especially if certain factors are at play—like using soaps or douching, which can disrupt the natural balance of bacteria and yeast in that area. If Anastasia has been using scented soaps or tight clothing, that could also contribute. However, because this is her third episode in a few months, I think it’s important that we investigate further to ensure we aren’t missing anything else. We’ll do a swab to confirm that it is Candida, the type of yeast that causes thrush, and also check for other potential underlying causes, such as her blood sugar levels to rule out diabetes, as well as her iron levels, since low iron can sometimes make her more prone to infections. In the meantime, we can start her on treatment to relieve her current symptoms and provide some advice to prevent future episodes. For example, avoiding scented soaps, wearing loose cotton underwear, and ensuring good hygiene habits without over washing, drying properly after washing can help.

Management

Management

  • Offer F2F to examine down below and also use of low vulvovaginal swab (NOT HVS in this case due to her age) for culture to confirm candida
  • Offer blood test for diabetes, ferritin, FBC.
  • Offer topical clotrimazole cream 2% TDS for 7 days
  • Hygiene Advice: Avoid synthetic underwear and tight clothing (Use cotton underwear), use non-scented soaps and avoid bubble baths, maintain good vulva hygiene, dry vagina properly after washing, do not use wet wipes on the genital skin
  • Follow up in 7 days to discuss results of swab and see how she is doing
  • Safety-net for worsening symptoms (fever, abdominal pain, unusual discharge)

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