Photo Rounds

Malodorous vaginal discharge

A 31-year-old woman presented to her family physician (FP) with a 3-week history of a malodorous vaginal discharge. She had no associated vaginal itching or pain. The patient indicated that she had been douching once a month to prevent odor, but this was no longer working. There was thin and off-white discharge upon speculum examination.

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A wet prep demonstrated clue cells in more than half of the epithelial cells and the FP diagnosed bacterial vaginosis (BV). BV is a clinical syndrome resulting from an alteration of the vaginal ecosystem. The odor of BV is caused by the aromatic amines produced by the altered bacterial flora in the vagina. Women with BV are at increased risk for human immunodeficiency virus, Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex virus-2, and they have an increased risk of complications after gynecologic surgery. BV is also associated with adverse pregnancy outcomes.

The FP recommended that the patient stop douching because it wouldn’t prevent or treat infections and could unfavorably influence the vaginal microscopic ecosystem. In this case, the patient had good results after being treated with oral metronidazole 500 mg bid for 7 days.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Bacterial vaginosis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:494-498.

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