A 35-year-old woman presents with a 2-day history of lower abdominal pain and a greenish-yellow, foul-smelling vaginal discharge. She reports no fever, nausea, or urinary symptoms. What are potential causes and the next steps?
This patient's symptoms of lower abdominal pain and a greenish-yellow, foul-smelling vaginal discharge are suggestive of bacterial vaginosis (BV), but pelvic inflammatory disease (PID) should also be considered given the abdominal pain. A pelvic examination and microscopy of the discharge (which would likely show clue cells in BV) should be performed. If BV is confirmed, the treatment is antibiotics. If there is any doubt about PID, it would be safer to treat for PID with appropriate antibiotics.