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In this scenario, the community pharmacist counsels a patient who has come in worried about a vaginal itch. The student must take a history, make a diagnosis, and suggest an appropriate over the counter medication.
Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.
You will need a student pharmacist and an actor for this OSCE station.
Thrush
Urinary tract infection
You are a pharmacist working in a community pharmacy. The patient is a 28-year-old female worried about a vaginal itch. They would like to speak with the pharmacist in private. They are in the consultation room waiting for you.
To do:
Conduct a thorough medical history assessment.
Based on the information gathered, formulate a treatment plan or, if necessary, recommend a referral to a healthcare provider or emergency services for further evaluation and management.
You have 10 minutes.
You have access to the BNF.
You are Sicilia Trelawney (Sih-sil-yuh, Tree-law-nee)
You can rephrase the opening statement for whatever feels most natural to you.
Opening statement: "I am super itchy 'down there' and it is really worrying me”
Patient information:
To be given if the student asks.
Name: Sicilia Trelawney
Age: 28
Past medical history:
“I was recently treated for a UTI with an antibiotic, and I completed the course last week.”
Medication History:
“I take my combined oral contraceptive pill"
If asked: "I don’t know which brand it is.”
Allergies:
“None.”
Symptoms:
“It’s like a cottage cream discharge.”
“Very itchy.”
“It burns when I urinate but only mildly – it's nothing like the UTI I had.”
Risk factors:
“I am not breastfeeding.”
“I am not pregnant.”
“I had these symptoms a few years ago – I can’t remember what the pharmacist gave me, but it worked.”
“No bleeding.”
“No current sexual partners. The last time I had sex was 7 months ago now”
“I got checked for sexually transmitted diseases when I got the antibiotic – all negative. I have not had any partners since way before that anyway.”
At this point, the student should inform you that they think that you have vaginal thrush/ candidiasis. The student should then tell you about the different options available e.g. oral capsule, pessary, internal cream, and external cream.
The student should also offer you advice on what you should do at home to ease discomfort and stop the thrush from reoccurring. If they do not, prompt them by asking:
“Is there anything I can do to ease the itch and stop the thrush from coming back?”
Any criteria marked in red must be met to pass this station.
Red Flags missed: 3
Referral Information for Thrush
Refer to Accident & Emergency (A&E) if:
Difficulty breathing or swallowing: This could indicate a severe allergic reaction to treatment or a complication from the infection that requires immediate medical attention.
Severe oral or genital pain with swelling and redness: If the symptoms are rapidly progressing, it could indicate cellulitis or another severe infection, necessitating urgent evaluation.
Refer for an Urgent GP Appointment if:
Thrush symptoms persist or worsen despite over-the-counter treatment: This could suggest a resistant strain of Candida or another underlying condition that needs medical management.
Recurrent thrush (four or more episodes in a year): Recurrent episodes could indicate an underlying condition such as diabetes, immunosuppression, or HIV, requiring further investigation and management.
Unusual or severe symptoms such as significant bleeding, severe itching, or pain: These could indicate a more serious underlying condition, such as a sexually transmitted infection (STI).
Thrush in a patient who is immunocompromised (e.g., HIV, chemotherapy, organ transplant): In immunocompromised patients, thrush can be more severe and require prompt medical evaluation and treatment.
National Health Service (NHS), 2024.Thrush in Pregnancy. [online] Available at:https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/thrush/[Accessed 23 August 2024].
National Health Service (NHS), 2024.Thrush in Men and Women. [online] Available at:https://www.nhs.uk/conditions/thrush-in-men-and-women/[Accessed 23 August 2024].
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