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Vaginal Discharge in a Young Woman



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Am Fam Physician. 2014 Jun 1;89(11):905-906.

A 22-year-old woman presented with malodorous vaginal discharge and soreness that began one week earlier. She had dyspareunia, but no itching, dysuria, or lower abdominal pain. She was not douching or using any local intravaginal chemical treatment. She had multiple sex partners and had chlamydia infection twice within the previous year. She had one pregnancy, which was uncomplicated.

Examination of the vulva was unremarkable. Speculum examination of the vagina revealed multiple small, erythematous macules covering the vaginal wall and ectocervix (see accompanying figure), and a moderate amount of homogeneous yellowish discharge. Microscopic examination of the vaginal secretions with saline showed a motile organism and an excessive number of leukocytes. Results of a potassium hydroxide preparation and rapid testing for chlamydia, gonorrhea, and human immunodeficiency virus infections were negative.


Figure.


Figure.

Question

Based on the patient's history, physical examination, and microscopy findings, which one of the following is the most likely diagnosis?

A. Bacterial vaginosis.

B. Irritant or allergic contact dermatitis.

C. Trichomoniasis.

D. Vulvovaginal candidiasis.

Author disclosure: No relevant financial affiliations.

Address correspondence to Nehal Patel, MD, at ntpat123@yahoo.com. Reprints are not available from the authors.

REFERENCES

1. Mayeaux E, Usatine R. Trichomonas vaginitis. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill Medical; 2009:338–340.

2. Egan M, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000;62(5):1095–1104.

3. Sonnex C. Colpitis macularis and macular vaginitis unrelated to Trichomonas vaginalis infection. Int J STD AIDS. 1997;8(9):589–591.

4. Krieger JN, Wolner-Hanssen P, Stevens C, Holmes KK. Characteristics of Trichomonas vaginalis isolates from women with and without colpitis macularis. J Infect Dis. 1990;161(2):307–311.

5. Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011;83(7):807–815.

6. Cram L, et al. Genitourinary infections and their association with pre-term labor. Am Fam Physician. 2002;65(2):241–248.

Contributing editor for Photo Quiz is John E. Delzell, Jr., MD, MSPH.

A collection of Photo Quizzes published in AFP is available at http://www.aafp.org/afp/photoquiz.

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto@aafp.org.


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