MEDizzy - A 29-year-old woman presents to the gynecologist complaining

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Gynecology (Set -1)

A 29-year-old woman presents to the gynecologist complaining of a “fishy” smelling vaginal odor noticeable during intercourse. Pelvic examination reveals a homogenous gray-white discharge, and a saline wet mount of vaginal epithelial cells is obtained (see image). What is the morphology of the organism that is causing this patient’s symptoms?

ExplanationThe correct answer is D. The term pleomorphic, gram-variable rod is used to describe Gardnerella vaginalis, which causes vaginosis that is characterized by a gray-white vaginal discharge with a fishy odor. Clue cells on saline wet mount are diagnostic and appear as vaginal epithelial cells covered with bacteria. Inflammatory cells often are present as well. Answer A is incorrect. Budding yeast and/or hyphae are used to describe Candida albicans, a fungus that causes “yeast infection,” a vulvovaginitis that presents with vulvar pruritus, dysuria, and a thick, adherent “cottage cheese-like” discharge. The organism is visualized on wet mount after addition of potassium hydroxide. Answer B is incorrect. The term gram negative diplococci is used to describe Neisseria gonorrhoeae, which can cause urethritis, cervicitis, and pelvic inflammatory disease. Presenting symptoms often include pain and mucopurulent vaginal discharge. These organisms often are found within surrounding neutrophils. Answer C is incorrect. The term gram-positive rod is used to describe Lactobacillus, which comprises part of the normal vaginal flora in adults.