Question

A patient you are assessing reports an increase in vaginal discharge that has a foul odor, but she does not report other symptoms. The patient has been in a monogamous relationship for 3 years. Which of the following would be the most useful for this patient? Select all that apply.
a. Evaluate her urine for increased white blood cells
b. Perform a Gram stain on the vaginal discharge
c. Run a pregnancy test
d. Test for an STI
e. Perform a whiff test

Accepted Answer

Step 1: Understand the clinical presentation. The patient reports increased vaginal discharge with a foul odor but no other symptoms, and she is in a monogamous relationship. This suggests a possible vaginal infection, such as bacterial vaginosis or another cause of abnormal discharge. Step 2: Consider diagnostic tests that directly assess the vaginal discharge. Performing a Gram stain on the vaginal discharge (option b) helps identify the presence of bacteria and their morphology, which is useful for diagnosing infections like bacterial vaginosis or candidiasis. Step 3: The whiff test (option e) involves adding potassium hydroxide (KOH) to the vaginal discharge to detect a characteristic fishy odor, which is a key diagnostic clue for bacterial vaginosis. Step 4: Testing for sexually transmitted infections (STIs) (option d) is important if there is suspicion of an STI, even in a monogamous relationship, because some infections can be asymptomatic or transmitted before the current relationship. Step 5: Evaluating urine for increased white blood cells (option a) is more relevant for urinary tract infections rather than vaginal infections, and a pregnancy test (option c) is useful if pregnancy status is unclear or symptoms suggest pregnancy-related issues, but neither directly addresses the foul-smelling discharge.

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Concetti chiave

Bacterial Vaginosis and Vaginal Discharge

Diagnostic Tests for Vaginal Infections

Clinical Relevance of Patient History and Symptoms