Vaginal Discharge

HISTORY:

Abnormal vaginal discharge for ‍ ‍hoursdays

Type: ‍clearwhiteyellowgreengray, ‍thickthin, ‍withwithout fishy smell

Volume: ‍increasednormaldecreased

‍vulvar rash

‍itching

‍burning sensation

‍pain during intercourse

‍bleeding between periods

‍bleeding after intercourse

‍pelvic pain



EXAM:

General appearance: ‍well-appearing

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic:

- External genitalia: ‍normal, ‍inguinal lymphadenopathy

- Vagina: ‍normal, discharge ‍normal, ‍malodorous

- Cervix: ‍normal

- Uterus: ‍normal, ‍no cervical motion tenderness

- Adnexa: -R ‍normal, -L ‍normal

- Tests performed: ‍Pap test, ‍HPV DNA, ‍vaginal culture, ‍chlamydia/gonorrhea, vaginal pH ‍< 4.5> 4.5, whiff test with KOH ‍negative

- Performed with chaperone



ASSESSMENT:

‍Yeast vaginitis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Vaginal swab

- Wet mount microscopy

- STI screening for chlamydia and gonorrhea

- Blood work: ‍HIV, ‍syphilis, ‍hepatitis B, ‍hepatitis C, ‍glucose, ‍HbA1C

- ‍Antifungals

- ‍Antibiotics

- ‍Probiotics

- Avoidance of irritants (soaps, bubble baths, douches, feminine sprays)

- Referral to gynecologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms do not improve or if develops fever or abdominal pai