VAGINITIS CASE 2

ANSWERS

What are the most likely diagnoses?

Refer to the table below.  The history,
physical, and tests are not diagnostic.  Either BV or trichomonas is most
likely – the new sex partner, the frothy discharge, the odor, and the elevated
pH are most consistent with these diagnoses.  However, the lack of good
clue cells throws a diagnosis of BV into doubt, and the lack of trichomonads and
copious white cells makes trichomoniasis uncertain.  But these markers are
not 100% sensitive or specific.  An iffy clue cell is less than 70%
specific, and internists spot trich less than 60% of the time.  Similarly,
we haven’t absolutely ruled out candida or other less common diagnoses.