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Ch. 20 - Urinary and Reproductive System Infections
Norman-McKay- Microbiology: Basic and Clinical Principles 2nd Edition
Norman-McKay2nd EditionMicrobiology: Basic and Clinical PrinciplesISBN: 9780137661619Not the one you use?Change textbook
All textbooksNorman-McKay 2nd EditionCh. 20 - Urinary and Reproductive System InfectionsProblem 3
Chapter 20, Problem 3

A patient you are assessing reports an increase in vaginal discharge that has a foul odor, but she does not report other symptoms. The patient has been in a monogamous relationship for 3 years. Which of the following would be the most useful for this patient? Select all that apply.
a. Evaluate her urine for increased white blood cells
b. Perform a Gram stain on the vaginal discharge
c. Run a pregnancy test
d. Test for an STI
e. Perform a whiff test

Verified step by step guidance
1
Step 1: Understand the clinical presentation. The patient reports increased vaginal discharge with a foul odor but no other symptoms, and she is in a monogamous relationship. This suggests a possible vaginal infection, such as bacterial vaginosis or another cause of abnormal discharge.
Step 2: Consider diagnostic tests that directly assess the vaginal discharge. Performing a Gram stain on the vaginal discharge (option b) helps identify the presence of bacteria and their morphology, which is useful for diagnosing infections like bacterial vaginosis or candidiasis.
Step 3: The whiff test (option e) involves adding potassium hydroxide (KOH) to the vaginal discharge to detect a characteristic fishy odor, which is a key diagnostic clue for bacterial vaginosis.
Step 4: Testing for sexually transmitted infections (STIs) (option d) is important if there is suspicion of an STI, even in a monogamous relationship, because some infections can be asymptomatic or transmitted before the current relationship.
Step 5: Evaluating urine for increased white blood cells (option a) is more relevant for urinary tract infections rather than vaginal infections, and a pregnancy test (option c) is useful if pregnancy status is unclear or symptoms suggest pregnancy-related issues, but neither directly addresses the foul-smelling discharge.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Bacterial Vaginosis and Vaginal Discharge

Bacterial vaginosis (BV) is a common cause of increased vaginal discharge with a foul odor, often without other symptoms. It results from an imbalance in the normal vaginal flora, particularly a decrease in lactobacilli and overgrowth of anaerobic bacteria. Recognizing BV is important for appropriate diagnosis and treatment.
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Diagnostic Tests for Vaginal Infections

Diagnostic tools such as Gram stain, whiff test, and STI screening help identify the cause of abnormal vaginal discharge. Gram stain can reveal bacterial morphologies, the whiff test detects amine odors indicating BV, and STI tests rule out sexually transmitted infections. Choosing the right tests guides effective management.
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Clinical Relevance of Patient History and Symptoms

Patient history, including sexual activity and symptom presentation, informs diagnostic decisions. A monogamous relationship reduces but does not eliminate STI risk. Absence of urinary symptoms makes urinary tract infection less likely, so targeted testing based on symptoms and risk factors is essential for accurate diagnosis.
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Related Practice
Textbook Question

A patient you are assessing reports an increase in vaginal discharge that has a foul odor, but she does not report other symptoms. The patient has been in a monogamous relationship for 3 years. Which of the following would be the most useful for this patient? Select all that apply.

a. Evaluate her urine for increased white blood cells

b. Perform a Gram stain on the vaginal discharge

c. Run a pregnancy test

d. Test for an STI

e. Perform a whiff test

Textbook Question

Which of the following does not fall into our current definition of TORCH infections?

a. Syphilis

b. Trichomoniasis

c. HIV

d. Rubella

e. Cytomegalovirus

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Textbook Question

A male patient is complaining of frothy discharge and painful urination. After negative NAAT testing, you will most likely prescribe:

a. Penicillin

b. Tetracycline

c. A cephalosporin

d. Metronidazole

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Textbook Question

How do lactobacilli limit infections in the vagina? Select all that apply.

a. They competitively exclude potential pathogens

b. They make hydrogen peroxide

c. They ferment fructose to make lactic acid

d. They lower the vaginal pH, which limits pathogen growth

e. They increase the rate of vaginal mucus secretion

Textbook Question

Factors that contribute to vulvovaginal candidiasis include:

a. Low vaginal pH

b. High nitrates in urine

c. Increased blood bilirubin levels

d. Increased estrogen levels

e. Taking a fluconazole drug

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Textbook Question

You see a corkscrew-like bacterial cell under dark field microscopy. If the sample came from __________, it is likely __________.

a. Genital lesions, leptospirosis

b. Urine, gonorrhea

c. Urine, syphilis

d. Genital lesions, syphilis

e. Vaginal discharge, chlamydia