What is the diagnosis and appropriate treatment for a female patient presenting with vaginal pruritus, vaginal fissures, and curdy white (cottage‑cheese) discharge?

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Last updated: September 30, 2026 • View editorial policy

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Diagnóstico: Candidíase Vulvovaginal

O diagnóstico é candidíase vulvovaginal (CVV) e o tratamento de primeira linha é fluconazol 150 mg dose única oral ou agentes tópicos azólicos intravaginais. 1

Confirmação Diagnóstica

A apresentação clínica descrita é clássica para CVV:

  • Prurido vaginal (sintoma cardinal)
  • Fissuras vaginais (sinal de inflamação severa)
  • Corrimento branco tipo "coalhada" ou "cottage cheese" (sinais florísticos) 2

Outros sinais esperados incluem eritema vulvar, edema, e pH vaginal normal (4.0-4.5) 2. A confirmação deve ser feita idealmente por:

  • Microscopia com KOH 10% mostrando hifas ou leveduras em brotamento (sensibilidade 50-70%)
  • Cultura vaginal para Candida (padrão-ouro, mas demora 48-72h)
  • PCR/NAAT (sensibilidade 90.9%, especificidade 94.1% - superior à microscopia clínica) 1

Armadilha comum: Menos de 50% dos casos têm microscopia positiva, então cultura ou teste molecular pode ser necessário se microscopia for negativa mas suspeita clínica alta 1.

Tratamento Recomendado

Para CVV Não-Complicada (caso mais provável):

Opção oral (mais conveniente):

  • Fluconazol 150 mg dose única 1, 2

Opções tópicas intravaginais (igualmente eficazes): 1

  • Clotrimazol 2% creme 5g/dia por 3 dias
  • Miconazol 200 mg supositório 1/dia por 3 dias
  • Terconazol 0.8% creme 5g/dia por 3 dias
  • Tioconazol 6.5% pomada 5g dose única

Se Apresentação Severa:

Fluconazol 150 mg a cada 72 horas por 2-3 doses totais 2

Se CVV Complicada (recorrente, severa, ou espécies não-albicans):

  • Terapia tópica por 7-14 dias OU
  • Fluconazol 150 mg a cada 72h por 3 doses 2

Considerações Importantes

Classificação: CVV é não-complicada em ~90% dos casos. Complicada se: recorrente (≥4 episódios/ano), severa, espécies não-albicans, diabetes, imunossupressão, ou gravidez 2.

Se falha terapêutica: Considerar C. glabrata (resistente a azóis). Tratamento alternativo: ácido bórico 600mg intravaginal/dia por 14 dias 2.

CVV recorrente: Após indução com 10-14 dias de terapia, manutenção com fluconazol 150 mg semanal por 6 meses 2.

Diagnóstico diferencial crítico: Vaginose bacteriana (corrimento fino, odor de peixe, pH >4.5) e tricomoníase (corrimento espumoso amarelo-verde) apresentam sintomas sobrepostos mas tratamentos completamente diferentes 3.

References

3
Research

Vaginitis: Diagnosis and Treatment.

American family physician, 2025

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