MEDizzy - A 24-year-old woman presents to her primary care physician

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Basic obstetrics

A 24-year-old woman presents to her primary care physician with a complaint of 1 week of increased vaginal discharge with an unpleasant odor. She is sexually active with one partner and uses oral contraception for birth control. A pregnancy test is negative. Gynecologic examination reveals a pink cervix and a thin white discharge. The discharge has a positive amine “whiff” test and a pH of 6. Wet saline mount microscopy yields the following image. Which of the following is the most likely diagnosis?

ExplanationA. Bacterial vaginosis is caused by an imbalance in vaginal flora, with reduced numbers of lactobacilli and increased proportions of bacteria such as Gardnerella, Mobiluncus, or Peptostreptococcus species. Signs of bacterial vaginosis include a thin white vaginal discharge, vaginal pH >4.5, fi shy odor on 10% potassium hydroxide “whiff” test, and clue cells on saline mount microscopy (visible in the center of the fi eld in the image).This diagnosis is established if three of these four criteria are met.