A 28 Years old white female presents with a 15-day history of malodorous vaginal discharge and pruritus. She reports that the smell is worse after intercourse and is accompanied by a white discharge. No significant medical or gynecological history. She is in a stable monogamous relationship and has never been pregnant. Which of the following diagnostic features is consistent with Bacterial vaginosis?
Answer: b) Vaginal fluid pH > 4.5, presence of clue cells on the smear and fishy odor on KOH mountVAGINAL INFECTIONSDiagnosticCriteria Differential Diagnosis of Vaginal infectionsNormalBacterialvaginosisCandidiasisTrichomoniasisBacterial (strep, staph, E.coli)Vaginal pH3.8-4.2>4.5<4.5>4.5>4.5DischargeClear,FlocculentThin, gray or white, adherent HomogenousWhite, curdy, Cottage- Cheese likeYellow to green Frothy adherentPurulentAmine odor (KOH,"whiff" test)AbsentPresent(Fishy)AbsentAbsentAbsentMicroscopicLactobacilliClue cells, coccoid Bacteria, No WBCMycelia,buddingYeast,pseudohyphaeTrichomonads WBC> 10/hpfMany WBCsMain patient ComplaintsNoneDischarge, bad odour- possibly worse after intercourseltching\burningdischargeFrothy discharge, bad odour, vulval pruritis, dysuria & multiple small punctuate strawberry spots on the vaginal vault and portio vaginalis of the cervix (strawberry vagina)Thin, watery discharge,pruritus
Vaginal fluid pH > 6, scanty secretions with increased para basal cells
Vaginal fluid pH > 4.5, presence of clue cells on the smear and fishy odor on KOH mount
Vaginal fluid pH > 4, presence of hyphae on KOH mount
Vaginal fluid pH > 5, motile trichomonads on microscopy
Miscellaneous (Gynae)