Vaginitis

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of vaginal ‍discomfortitchingburningdischarge

Symptoms include:

‍vaginal discomfort

‍vaginal itching

‍burning

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍unusual odor

‍painful urination

‍painful intercourse

‍abnormal bleeding



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

‍douching

‍risk factors for STIs

no history of: ‍vaginitis, ‍sexually transmitted infections, ‍diabetes, ‍HIV, ‍immunodeficiency

no use of: ‍recent antibiotics, ‍contraceptives, ‍hormone replacement therapy





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

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

Anorectal: DRE ‍normal, ‍blood, ‍mass, anus ‍

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, trichomoniasis, atrophic vaginitis, irritative vaginitis, desquamative inflammatory vaginitis, foreign body, chlamydia, gonorrhea, herpes infection, cervicitis, vaginal cancer, pelvic inflammatory disease, endometritis, contact dermatitis, allergic reaction, lichen sclerosus, lichen planus, vulvodynia, vulvar vestibulitis syndrome





PLAN:

Investigations:

- Vaginal culture

- Wet mount microscopy

- STI screening

- Blood work: ‍HIV, ‍Syphilis, ‍Hepatitis B, ‍Hepatitis C, ‍Glucose, ‍HbA1C

Treatments:

- ‍Vaginal antifungals

- ‍Fluconazole

- 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