Hy 2396 Sexually active young lady

[tommyk]

Hy 2396
q) 18-year-old girl presents to the office with a 1 week history of a malodorous vaginal discharge. She is sexually active and uses a diaphragm. On examination, a thin, white discharge is seen. A "fishy" odor is produced when KOH is added to the discharge. The vaginal fluid has a low pH. In a microscopic slide, what will you see? What is the primary disease? What bug causes this disease? What is the pharmacological solution? What are the side effects of this drug?
1-Pseudohyphae
2-Budding hyphae
3-Gram negative diplococci
4-Small, oval shaped organisms moving
5-Lactobacilli
6-Clue Cells













































































































a) #6. Bacterial vaginosis (BV) is characterized by excessive discharge and odor. It is one of the main causes of vaginitis in women of childbearing age. Although BV is seen predominantly in sexually active premenopausal women, it does not appear to be closely associated with sexual activity and is not considered a sexually transmitted disease. For many years, the exact microbiologic cause of this infection was unknown; however, it is now regarded as a result of the synergism among various bacteria, including Gardnerella vaginalis, anaerobic gram-negative rods, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and Mobiluncus species. G. vaginalis is found as part of the vaginal flora in approximately one third of sexually active women. Without a critical concentration of other vaginal bacteria, particularly anaerobes, this organism is not thought to be responsible for symptoms. Organic acid metabolites of anaerobes predominate in these specimens, and the resolution of symptoms correlates with the appearance of metabolites produced by Lactobacillus and streptococcal species. The replacement of lactobacilli by G. vaginalis, anaerobes, Mobiluncus, and genital mycoplasmas is a characteristic feature of bacterial vaginosis. Patients with BV may have a variety of symptoms or none at all. As many as 50% may be asymptomatic, whereas 50% to 70% complain of an unpleasant, fishy or musty vaginal odor. They also report increased vaginal discharge. The onset of odor and discharge associated with BV is evenly distributed throughout the menstrual cycle, and local discomfort is rarely a problem. The diagnosis of BV is made by examination of the patient and the discharge. The discharge is typically homogeneous, grayish white to yellowish white, and partially adherent to the vulva and vaginal walls. Underlying edema or erythema of the vulva or vagina is atypical. The pH of this vaginal discharge is greater than 4.7. When one drop of KOH is added to one drop of discharge, an intense amine odor produces a positive whiff test result. Typically, on normal saline wet preparation, this discharge has a paucity of leukocytes and a predominance of clue cells, produced by the adherence of G. vaginalis to epithelial cells. By wet preparation, clue cells are best identified by a stippled birefringence that so densely covers the epithelial cell that the normal borders and nuclei are obscured. By Gram's stain, clue cells can be identified as epithelial cells almost totally covered by small gram-negative rods. A paucity of other organisms can be seen in the background. The single most reliable sign is the presence of clue cells. Culture on a specific medium is rarely useful. BV-associated organisms may be part of the normal vaginal flora, although concentrations are typically higher when BV is present. The most effective treatment for BV is metronidazole. Increasing experience suggests that vaginal therapy with metronidazole gel or clindamycin cream is also effective. The risk factors in recurrence are incompletely understood, but BV may develop more often in users of diaphragms. Recall that Gram-negative diplococci are seen in gonorrhea. Women with gonorrhea may complain of mucopurulent vaginal discharge, dyspareunia, and dysuria. Lactobacilli are normal vaginal flora. They are not seen in patients with active BV. Pseudohyphae are seen in the potassium hydroxide preparation of a vaginal discharge of patients with candidiasis. Candidiasis presents with itching, irritation, and dyspareunia. Discharge is white and clumpy and looks a bit like cottage cheese.

[tommyk]

Oh yeah, if you see swimming oval “things” under the scope, they are likely Trichomonads.