31

CASE 31


A 26-year-old woman came to a city sexually transmitted disease (STD) clinic complaining of a profuse yellow, foamy vaginal discharge with foul odor. The discharge began 2 days before with vulvar irritation and itching. She said she was also having pain during intercourse.


The patient had been sexually promiscuous with multiple partners. The medical history was unremarkable.



PHYSICAL EXAMINATION



VS: Normal

PE: Pelvic examination revealed homogeneous vaginal discharge and vulvar erythema. A diffuse macular erythematous lesion of the cervix (“strawberry cervix,” Fig. 31-1) was noted. Lower abdominal tenderness was also noted.

image

FIGURE 31-1 “Strawberry cervix” in this patient.


(Courtesy of Centers for Disease Control and Prevention, Atlanta, GA.)



LABORATORY STUDIES



Blood


Not done



Imaging


Not done



Diagnostic Work-Up


Table 31-1 lists the likely causes of the woman’s illness (differential diagnosis). The vaginal pH is measured on Nitrazine paper, and a fishy odor released upon application of 10% potassium hydroxide to a vaginal swab sample (“KOH amine test”) suggested trichomoniasis or bacterial vaginosis. The following additional studies may aid the specific microbiologic diagnosis:


• Wet mount examination of vaginal discharge

• Gram stain to reveal bacteria or yeasts

TABLE 31-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Bacterial vaginosis (Gardnerella/Mobiluncus)

Candidiasis (Candida albicans)

Trichomoniasis (Trichomonas vaginalis)

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 31

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