V.L. is a 30-year-old G2, P2, A0 who delivered her second child in 1987 and then had a postpartum tubal ligation. She is being followed now for chronic candidiasis. Her history is as follows: Prior to the birth of her second child, V.L. had reported having yeast infections two to three times a year. During that pregnancy, she was treated on three occasions with an antifungal cream at bedtime for seven nights. Her infections continued postpartum to the point that now she states she always has a yeast infection. Her medical history is noncontributory. She has been tested and is negative for diabetes. Her GYN history is unremarkable except for the Monilia infections. She does not douche. She does not smoke or use drugs, and she drinks a glass of wine one to two times a month.
You have discussed some basic preventive measures including wearing cotton underwear, avoiding sweets, using mild soaps/detergents, and not wearing underwear at night. V.L. does notice some improvement after a one- to two-week course of antifungal creams but only for about a week. Please discuss a management plan.