Vaginal Symptoms

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of vaginal ‍symptomsdischargeitchingburningrash

Symptoms include:

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍vaginal odor

‍itching

‍burning

‍rash

‍swelling

‍pelvic pain

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍vaginal bleeding

‍dysuria

‍frequency

‍fever, up to ‍°, over ‍ ‍hoursdays

‍bleeding between periods

‍bleeding after intercourse

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Last menstrual period: ‍ ‍daysweeksmonths ago

Contraception: ‍yesno ‍oral contraceptives

Condom use: ‍alwayssometimesnever

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍use of scented products

‍wearing tight unbreathable clothing

‍unprotected sex

‍multiple sexual partners

‍douching

no history of: ‍vaginal yeast infections, ‍vaginal bacterial infections, ‍sexually transmitted infections, ‍vaginal atrophy

no use of: ‍antibiotics, ‍contraceptives, ‍hormone replacement therapy





EXAM:

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 infection ‍likelysuspectedpossible

DDx: yeast infection, bacterial vaginosis, irritative vaginitis, trichomoniasis, STI, chlamydia, gonorrhea, herpes, physiologic discharge, atrophic vaginitis, cervicitis, foreign body, allergic reaction, contact dermatitis, desquamative inflammatory vaginitis, vaginal atrophy, vaginal cancer, pelvic inflammatory disease, endometritis, vulvodynia, vulvar vestibulitis syndrome, lichen sclerosus, lichen planus, genital warts, molluscum contagiosum, bartholinitis





PLAN:

Investigations:

- Vaginal swab

- Wet mount microscopy

- STI screening for chlamydia and gonorrhea

Treatments:

- ‍Vaginal antifungals

- ‍Oral 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