A 32-year-old woman, gravida 1 para 1, comes to the office for vaginal discharge. The patient has no chronic medical conditions and takes no daily medications. Her last menstrual period was 3 weeks ago. The patient has recently become sexually active with a new partner and uses an intrauterine device for contraception. Cytology of the discharge is shown in the image below: Which of the following best describes the predominant organism causing this patient's condition?

Question

A 32-year-old woman, gravida 1 para 1, comes to the office for vaginal discharge.  The patient has no chronic medical conditions and takes no daily medications.  Her last menstrual period was 3 weeks ago.  The patient has recently become sexually active with a new partner and uses an intrauterine device for contraception.  Cytology of the discharge is shown in the image below:  Which of the following best describes the predominant organism causing this patient's condition?

Quizplus · Accepted Answer

11ec160b_37f3_36cf_9249_b353bb46e583_MD0001_00 Bacterial vaginosis (BV) is most commonly caused by an overgrowth of the facultative anaerobic, gram-variable rod Gardnerella vaginalis and loss of normal lactobacilli flora. A classic symptom is a thin, malodorous, grayish-white vaginal discharge. The odor becomes more prominent with the addition of potassium hydroxide (whiff test) to a sample due to the anaerobes that release amines. Wet mount microscopy of the discharge and cytologic smears characteristically show clue cells, which are vaginal squamous epithelial cells covered with multiple, small, adherent G vaginalis organisms. Treatment is with metronidazole or clindamycin. (Choice B) Candida albicans vaginitis is associated with intense vaginal pruritus; white, curd-like discharge; and labial erythema. Pseudohyphae of this diploid fungus are seen on potassium hydroxide preparations of the vaginal discharge. (Choices C and D) Neisseria gonorrhoeae and Chlamydia trachomatis are transmitted sexually, commonly together. These organisms can cause cervicitis, which typically presents with a mucopurulent cervical discharge. Microscopy of N gonorrhoeae shows gram-negative intracellular diplococci, and C trachomatis microscopy is typically normal or shows leukocytes. (Choice E) Trichomonas vaginalis is a flagellated protozoan that causes trichomoniasis, which is associated with a yellow-green, frothy discharge. Motile, flagellated trophozoites are seen on wet mount microscopy. (Choice F) Human papillomavirus is a naked DNA virus that can cause condylomata acuminata and cervical cancer. Condylomata are commonly caused by strains 6 and 11, and oncogenic strains include types 16 and 18. Human papillomavirus infections do not typically cause vaginal discharge. Educational objective: Bacterial vaginosis is associated with a grayish-white, malodorous vaginal discharge due to an overgrowth of Gardnerella vaginalis, a facultative anaerobic, gram-variable rod. Clue cells (squamous epithelial cells covered with bacterial organisms) are seen on wet mount microscopy or cytology.

A 32-Year-Old Woman, Gravida 1 Para 1, Comes to the Office