VAGINITIS

This is an on-line exercise.  Read the
accompanying review article first.  Next read the hypothetical cases and
try to answer the questions before clicking through to the
answers.

I. Read through the Review Article Current
Concepts: Vaginitis, Sobel Jack D.  New England Journal of Medicine,
Vol. 337, No. 26, 1896-1903.

II. Sample Cases

Case 1

Ms. A. is a 56 year-old widow who comes to the
clinic complaining of vaginal discharge over the past 3 weeks associated with
mild itching of the vulva and perineum.  The discharge is
whitish/yellowish.  Although for many years she has noted intermittent
light, vaginal discharge, this is a different problem.  There is no
abdominal pain, pelvic pain, urinary complaint, fever, or history of vaginal
infection. 

1.  What are the likely diagnoses?
Answer

2.  What more history do you need?
Answer

3.  What will you be looking for on exam?
Answer

4.  How are wet mount and KOH (or other
fungal stain) done?  What will you be looking for on these?  How is
the whiff test performed?
Answer

5.  When would you do a genprobe for
chlamydia and GC?   Answer

Case 2

Ms. B., a 23 year-old woman, complains of
vaginal discharge for one week.  She denies itching, irritation, urinary
symptoms, or abdominal pain.  She says she frequently has mild discharge
during her menses, but this is worse, and her new boyfriend told her there’s a
bad odor.  Pelvic exam reveals normal external genitalia, a frothy
whitish discharge in the vagina, no cervical discharge or tenderness, and mild
diffuse tenderness of the uterus and adnexa.  The discharge smells fishy
before adding KOH; afterwards the smell is the same.  The pH is
5.5.  Wet mount reveals no trichomonads, a few white cells, and several
squamous cells that have mild stippling of the borders —  they are +/-
clue cells.  KOH prep is negative for hyphae or yeast. 

1.  What are the most likely
diagnoses?      Answer

2.  What would you recommend
next?       Answer