A 16-year-old, previously healthy girl comes to the office due to vaginal discharge that began 5 days ago. The discharge is grayish-white and fishy smelling. The patient is sexually active with a male partner and occasionally uses condoms. Temperature is 36.7 C (98.1 F), blood pressure is 106/52 mm Hg, and pulse is 78/min. Examination shows a small amount of grayish discharge in the vaginal vault. The cervix appears normal. Which of the following would most likely be seen on wet mount microscopy?

Question

A 16-year-old, previously healthy girl comes to the office due to vaginal discharge that began 5 days ago.  The discharge is grayish-white and fishy smelling.  The patient is sexually active with a male partner and occasionally uses condoms.  Temperature is 36.7 C (98.1 F), blood pressure is 106/52 mm Hg, and pulse is 78/min.  Examination shows a small amount of grayish discharge in the vaginal vault.  The cervix appears normal.  Which of the following would most likely be seen on wet mount microscopy?

Quizplus · Accepted Answer

11ec160b_37f3_ac00_9249_91f758ca28d6_MD0001_00 This patient's clinical presentation is most consistent with bacterial vaginosis (BV). BV is caused by an imbalance of the vaginal bacterial flora (eg, decreased lactobacilli colonization) and is associated with sexual activity, cigarette smoking, and vaginal douching. The decreased lactobacilli colonization causes a subsequent increase in vaginal pH and overgrowth of anaerobic bacteria (eg, Gardnerella vaginalis), which generate malodorous amines. The amines cause the characteristic grayish-white, fishy-smelling discharge with no associated vaginal inflammation. Wet mount microscopy of the discharge shows clue cells (squamous epithelial cells with adherent bacteria). Application of potassium hydroxide to the discharge produces an amine odor (ie, positive whiff test). Treatment is with metronidazole or clindamycin. (Choice B) A wet mount with epithelial cells and rare leukocytes is consistent with normal vaginal discharge (ie, physiologic leukorrhea). Physiologic leukorrhea is not malodorous. (Choice C) Gram stain showing gram-negative intracellular diplococci is consistent with Neisseria gonorrhoeae cervicitis, which is characterized by cervical erythema, friability, and purulent cervical discharge. (Choice D) A wet mount of trichomoniasis would show leukocytes and pear-shaped organisms (flagellated trophozoites). Trichomonas vaginitis typically presents with vulvovaginal erythema and frothy, yellow-green vaginal discharge; patients with Trichomonas cervicitis classically have a cervix with punctate hemorrhage (ie, strawberry cervix). (Choice E) Pseudohyphae with leukocytes are seen in Candida vaginitis, which would present with thick, white vaginal discharge and associated vaginal inflammation (eg, vaginal erythema, pruritus). Educational objective: Bacterial vaginosis is caused by a disruption of the vaginal bacterial flora and is characterized by a thin, gray-white, malodorous vaginal discharge. Clue cells (squamous epithelial cells with adherent bacteria) are seen on wet mount microscopy. __________ References: Vaginitis. (http://www.ncbi.nlm.nih.gov/pubmed/21524046)

A 16-Year-Old, Previously Healthy Girl Comes to the Office Due