NR602 WEEK 7 I HUMAN CASE FINAL DIAGNOSIS
INFECTIOUS VULVOVAGINITIS CHAMBERLAIN
UNIVERSITY
Case Study Analysis
Patient Presentation:
• Chief Complaint (CC): Vaginal itching, burning, abnormal
discharge, or odor.
• History of Present Illness (HPI): Duration of symptoms, any
recent antibiotic use, new sexual partner, douching, use of scented
hygiene products, or recent illness.
• Past Medical History (PMH): Any previous vaginal infections,
sexually transmitted infections (STIs), diabetes, or
immunosuppressive conditions.
• Medications: Recent antibiotic use, steroids, birth control.
• Sexual History: Number of partners, condom use, history of STIs.
• Menstrual History: Last menstrual period, cycle regularity.
• Physical Exam:
o External genitalia: Redness, swelling, lesions.
o Speculum exam: Color, consistency, and odor of vaginal
discharge.
o Bimanual exam: Uterine/adnexal tenderness.
Differential Diagnosis
1. Bacterial Vaginosis (BV)
o Cause: Overgrowth of Gardnerella vaginalis and anaerobes.
, o Symptoms: Thin, grayish-white discharge, fishy odor,
minimal inflammation.
o Diagnosis:
▪ Amsel’s Criteria (3 out of 4 required):
1. Thin, homogenous discharge
2. Positive whiff test (fishy odor with KOH)
3. Clue cells on microscopy
4. pH > 4.5
▪ Nugent Score from Gram stain.
2. Vulvovaginal Candidiasis (VVC) (Yeast Infection)
o Cause: Candida albicans overgrowth.
o Symptoms: Thick, white, curd-like discharge, itching,
burning.
o Diagnosis:
▪ pH < 4.5 (normal)
▪ KOH wet mount: Budding yeast or pseudohyphae.
▪ Culture if recurrent or atypical.
3. Trichomoniasis
o Cause: Trichomonas vaginalis (protozoan).
o Symptoms: Green/yellow frothy discharge, foul odor, vulvar
irritation.
o Diagnosis:
▪ pH > 4.5
▪ Motile trichomonads on wet mount.
▪ NAAT testing (gold standard).
▪ Strawberry cervix (petechiae).
4. Chlamydia/Gonorrhea Cervicitis
o Cause: Chlamydia trachomatis, Neisseria gonorrhoeae.
o Symptoms: Mucopurulent cervical discharge, dysuria, post-
coital bleeding.
o Diagnosis: NAAT testing.
5. Atrophic Vaginitis (in postmenopausal women)
o Cause: Low estrogen levels.
o Symptoms: Dryness, irritation, dyspareunia, scant yellow
discharge.
INFECTIOUS VULVOVAGINITIS CHAMBERLAIN
UNIVERSITY
Case Study Analysis
Patient Presentation:
• Chief Complaint (CC): Vaginal itching, burning, abnormal
discharge, or odor.
• History of Present Illness (HPI): Duration of symptoms, any
recent antibiotic use, new sexual partner, douching, use of scented
hygiene products, or recent illness.
• Past Medical History (PMH): Any previous vaginal infections,
sexually transmitted infections (STIs), diabetes, or
immunosuppressive conditions.
• Medications: Recent antibiotic use, steroids, birth control.
• Sexual History: Number of partners, condom use, history of STIs.
• Menstrual History: Last menstrual period, cycle regularity.
• Physical Exam:
o External genitalia: Redness, swelling, lesions.
o Speculum exam: Color, consistency, and odor of vaginal
discharge.
o Bimanual exam: Uterine/adnexal tenderness.
Differential Diagnosis
1. Bacterial Vaginosis (BV)
o Cause: Overgrowth of Gardnerella vaginalis and anaerobes.
, o Symptoms: Thin, grayish-white discharge, fishy odor,
minimal inflammation.
o Diagnosis:
▪ Amsel’s Criteria (3 out of 4 required):
1. Thin, homogenous discharge
2. Positive whiff test (fishy odor with KOH)
3. Clue cells on microscopy
4. pH > 4.5
▪ Nugent Score from Gram stain.
2. Vulvovaginal Candidiasis (VVC) (Yeast Infection)
o Cause: Candida albicans overgrowth.
o Symptoms: Thick, white, curd-like discharge, itching,
burning.
o Diagnosis:
▪ pH < 4.5 (normal)
▪ KOH wet mount: Budding yeast or pseudohyphae.
▪ Culture if recurrent or atypical.
3. Trichomoniasis
o Cause: Trichomonas vaginalis (protozoan).
o Symptoms: Green/yellow frothy discharge, foul odor, vulvar
irritation.
o Diagnosis:
▪ pH > 4.5
▪ Motile trichomonads on wet mount.
▪ NAAT testing (gold standard).
▪ Strawberry cervix (petechiae).
4. Chlamydia/Gonorrhea Cervicitis
o Cause: Chlamydia trachomatis, Neisseria gonorrhoeae.
o Symptoms: Mucopurulent cervical discharge, dysuria, post-
coital bleeding.
o Diagnosis: NAAT testing.
5. Atrophic Vaginitis (in postmenopausal women)
o Cause: Low estrogen levels.
o Symptoms: Dryness, irritation, dyspareunia, scant yellow
discharge.
