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Patients should seek urgent medical attention if they develop: Severe symptoms including extensive vulval swelling or ulceration Systemic features such as fever Pregnancy with severe symptoms Immunocompromised state with infection Unusual vaginal discharge with offensive odour, particularly if accompanied by pelvic pain, which suggests possible pelvic inflammatory disease requiring prompt antibiotic therapy Any vaginal bleeding outside normal menstruation It is important to note that over-the-counter fluconazole has specific licensing restrictions and may not be available without prescription for all patients

In elderly subjects, melatonin secretion had declined substantially from younger baseline levels

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