A 39 year old nulligravid woman comes to the physician because of a persistent vaginal itch


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A 39 year old nulligravid woman comes to the physician because of a persistent vaginal itch, vaginal discharge, and Dysuria. She has had these same symptoms several times over the past 2 years and each time has been diagnosed with Candida Vulvovaginitis. On physical examination, she has a thick, white vaginal discharge and significant vulvar and vaginal erythema. A potassium KOH smear shows pseudohyphae; the normal saline smear is negative. Which of the following is the most appropriate next step in management?

A. Coagulation studies
B. Metronidazole
C. Erythromycin
D. Screen for diabetes
E. Biopsy