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. (NCLEX/HESI/TEAS)
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.

Verified step by step guidance

1. Identify the symptoms reported by the patient: increase in vaginal discharge with a foul odor.
2. Consider the possible causes of these symptoms, such as bacterial vaginosis or sexually transmitted infections (STIs).
3. Evaluate the usefulness of each option: a. Evaluating urine for white blood cells is more relevant for urinary tract infections, not vaginal discharge.
4. b. Performing a Gram stain on the vaginal discharge can help identify bacterial infections, such as bacterial vaginosis.
5. e. Performing a whiff test is a quick diagnostic test for bacterial vaginosis, which is characterized by a fishy odor.

Key Concepts

Vaginal Discharge and Its Characteristics

Vaginal discharge can vary in color, consistency, and odor, providing important clues about a woman's reproductive health. An increase in discharge with a foul odor may indicate an infection, such as bacterial vaginosis or a sexually transmitted infection (STI). Understanding the normal versus abnormal characteristics of vaginal discharge is crucial for diagnosis and treatment.

Diagnostic Tests for Vaginal Infections

Various diagnostic tests can help identify the cause of abnormal vaginal discharge. A Gram stain can differentiate between types of bacteria present, while a whiff test can indicate bacterial vaginosis by producing a fishy odor when potassium hydroxide is added. Testing for STIs is also essential, especially in sexually active individuals, to rule out infections that may present with similar symptoms.

Importance of Patient History and Relationship Status

A patient's sexual history and relationship status are vital in assessing the risk of STIs and other infections. In this case, the patient has been in a monogamous relationship for three years, which may lower the likelihood of certain STIs but does not eliminate the risk. Understanding the context of the patient's sexual health can guide appropriate testing and management strategies.