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Review Question - QID 109992

QID 109992 (Type "109992" in App Search)
A 24-year-old woman calls her gynecologist complaining of vaginal odor and vaginal discharge. She had an intrauterine device placed last year and does not use condoms with her boyfriend. She has a past medical history of constipation and depression. She recently was successfully treated for a urinary tract infection with a 2-day course of antibiotics. Physical exam demonstrates an off-white vaginal discharge and a strong odor. Pelvic exam demonstrates an absence of cervical motion tenderness and no adnexal tenderness. Which of the following is the most likely diagnosis?

Anaerobic bacteria overgrowth within the vagina

67%

8/12

Inflammatory bacterial infection

25%

3/12

Insufficiently treated urinary tract infection

8%

1/12

Physiologic discharge secondary to normal hormonal fluctuations

0%

0/12

Pregnancy within the uterine tubes

0%

0/12

Select Answer to see Preferred Response

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This patient is presenting with symptoms of bacterial vaginosis (anaerobic bacteria overgrowth within the vagina).

Bacterial vaginosis typically occurs secondary to vaginal dysbiosis as a result of antibiotic use. Symptoms include a fishy vaginal odor and white, gray, or clear discharge. Symptoms of pain and pruritus are absent in this condition as it is not an inflammatory process. Clue cells can be seen on wet mount and cultures will grow Gardnerella vaginalis (since anaerobic bacteria cannot be cultured easily). Treatment is targeted at anaerobes with metronidazole.

Incorrect Answers:
Answer 2: Inflammatory bacterial infection describes chlamydia or gonorrhea which would present with pain, pruritus, and yellow discharge.

Answer 3: Insufficiently treated urinary tract infection would present with symptoms of dysuria.

Answer 4: Physiologic discharge secondary to normal hormonal fluctuations describes mittelschmerz, which presents with pelvic pain and a clear discharge associated with ovulation.

Answer 5: Pregnancy within the uterine tubes describes an ectopic pregnancy which presents with pelvic pain and symptoms of pregnancy.

Bullet Summary:
Bacterial vaginosis presents with a fishy odor, a white discharge, and an absence of inflammatory symptoms (pain and pruritus) typically secondary to antibiotic use.

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