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Simple cases
Case 63
A 42 -year-old female consults you because of vaginal discharge.
History
Do you have allergies, hay fever or asthma?
No
This question isn't helpful in this clinical setting.
Tell me about the discharge.
There isn't much discharge; it is foamy, gray and smells terrible.
The nature of the vaginal discharge is essential in the diagnosis. Unfortunately, in daily practice, you will rarely get an answer as precise as this one.
Do you have burning on urination?
No
This question helps limit the differential diagnostic considerations.
Do have itching?
No.
Subjective symptoms can aid the differential diagnostic process and must not be forgotten when planning therapy.
Do you have any other illnesses?
No.
One should always ask this question, but here the answer is not helpful.
When did you last have sexual intercourse?
Five days ago, with my husband.
The sexual history is essential when confronted with vaginal discharge.
How long have you have the discharge?
I don't know exactly, maybe for a few weeks.
The time course can point you towards the right diagnosis.
Lesion
Choose the right efflorescences:
An ulcer is a skin defect involving epidermis and dermis; it is not present here.
No small blisters are visible.
An erosion is a superficial defect with loss of epidermis: no such lesion is seen.
The genitalia appear normal for the patient's age.
Correct. The patient has vaginal discharge and no primary skin lesion.
Diagnosis
Choose the right diagnosis:
There is no urethritis, since the patient has no dysuria.
The nature of the discharge described by the patient best fits this diagnosis.
Herpetic vulvovaginitis is associated with pain and skin lesions.
There is no dysuria and the discharge is not purulent.
Therapy
Choose the right therapy(ies):
Therapy for candidiasis but usually as single dose.
Treatment of choice.
Therapy for gonorrhea.
Topical therapy can be tried with clindamycin or metronidazole creams which must be administered vaginally for 7 days.
Therapy for nonspecific urethritis.
