Vaginal Discharge

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of abnormal vaginal discharge

Described as ‍clearwhiteyellowgreengray and ‍thickthin, ‍withwithout fishy smell

Volume ‍increasednormaldecreased



Associated symptoms: *Try using right-click for negatives*

‍vulvar rash

‍itching

‍burning sensation

‍pain during intercourse

‍bleeding between periods

‍bleeding after intercourse

‍pelvic pain

‍lower abdominal pain

‍dysuria

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍fatigue

‍swollen lymph nodes in the groin area



Contributing factors:

‍STI risk factors

‍unprotected sex

‍use of scented products

‍wearing tight unbreathable clothing

‍pregnancy

no history of: ‍yeast vaginitis, ‍bacterial vaginosis, ‍sexually transmitted infections, ‍menopause

no use of: ‍recent antibiotics, ‍steroids, ‍contraceptives





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 





ASSESSMENT:

‍Yeast vaginitis ‍likelysuspectedpossible

DDx: bacterial vaginosis, yeast infection, trichomoniasis, sexually transmitted infections (chlamydia, gonorrhea), discharge due to irritants, physiologic discharge, atrophic vaginitis, cervicitis, foreign body reaction, allergic reaction, contact dermatitis, desquamative inflammatory vaginitis, vaginal atrophy, vaginal cancer, pelvic inflammatory disease, endometritis, hormonal imbalance, diabetes mellitus





PLAN:

Investigations:

- Vaginal swab

- Wet mount microscopy

- STI screening for chlamydia and gonorrhea

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

Treatments:

- ‍Antifungals

- ‍Antibiotics

- ‍Probiotics

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

Further care:

- Referral to gynecologist

- Follow-up in ‍ ‍daysweeks

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