Vaginal Symptoms

HISTORY:

Vaginal ‍symptomsdischargeitchingburningrash for ‍ ‍hoursdays

‍vaginal discharge, ‍clear, ‍thin

‍fishy smell

‍vaginal odor

‍itching

‍burning

‍rash

‍swelling

‍pelvic pain

‍abdominal pain

‍vaginal bleeding

‍dysuria

‍frequency

‍fever

‍bleeding between periods

‍bleeding after intercourse

Last menstrual period: ‍ ‍daysweeksmonths ago

Contraception: ‍yesno ‍oral contraceptives

Condom use: ‍alwayssometimesnever

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

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 infection ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Vaginal swab

- Wet mount microscopy

- STI screening for chlamydia and gonorrhea

- ‍Vaginal antifungals

- ‍Oral 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