Nokea
Your 30 year old female patient is c/o bad-smelling vaginal discharge with mild itching for about 3 weeks. Douching did not help. Denies painful urination or intercourse. She noticed the smell increased after intercourse and during her period last week. There are no lesions on the perineum. No lymphadenopathy. On speculum examination, there is a thin gray-white discharge. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled border (clue cells). What type of vaginitis best describes the findings?
Correct Answer: C
Rationale: The correct answer is C: Bacterial vaginosis. The key findings in this scenario point towards bacterial vaginosis. The presence of thin gray-white discharge, fishy odor with KOH, pH over 4.5, and clue cells on wet prep are classic for bacterial vaginosis. Trichomonas vaginitis (choice A) typically presents with yellow-green frothy discharge and motile trichomonads on microscopy. Candida vaginitis (choice B) is characterized by thick, white, cottage cheese-like discharge and budding yeast or pseudohyphae on microscopy. Atrophic vaginitis (choice D) usually occurs in menopausal women due to estrogen deficiency and presents with thin, pale vaginal walls and vaginal dryness. In this case, the absence of these findings makes bacterial vaginosis the most likely diagnosis.