A 40-year-old woman presents with itchy, white vaginal discharge and vulval irritation. She has no fever or abdominal pain. What is the most appropriate treatment?

• A. Fluconazole
• B. Clotrimazole
• C. Metronidazole
• D. Miconazole

Answer: (B)

Symptoms point to vulvovaginal candidiasis. The itch plus thick white discharge and vulvar irritation in an afebrile patient is classic for a candida infection, not for bacterial vaginosis or trichomonas, which would have different discharge characteristics and often other symptoms. The best initial treatment for uncomplicated candidal vaginitis is an azole antifungal given locally, because it delivers high concentrations directly to the site with minimal systemic exposure and rapid relief. A topical azole such as clotrimazole is a common, effective option for this scenario. Oral fluconazole could also treat it, but topical therapy is typically preferred for uncomplicated cases due to fewer systemic effects. Metronidazole would not treat Candida, and while another topical azole like miconazole would also work, the chosen answer reflects clotrimazole as a standard first-line topical option.