Patient Presentation
The patient, B.B., a 21 year old, G1P0 at 36 weeks gestation presented to
the clinic for her scheduled prenatal visit. Her pregnancy had been
uncomplicated and progressing along well. When the patient was asked if
she had any problems or concerns, she reported increased vaginal
discharge, vaginal itching and odor for about one week. The patient denied
dysuria or dyspareunia. When asked why she had not reported these symptoms
sooner, she explained that she thought the discharge was normal at first
and expected the symptoms to resolve.
Differential Diagnosis
Bacterial vaginosis/vaginitis, chlamydia, gonorrhea, trichomoniasis
Diagnosis
The patient was prepared for a speculum exam, and the exam revealed
increased milky white vaginal discharge and a “fishy” odor. A sample of
the discharge was taken and a wet mount was created which showed clue
cells and a positive whiff test. The vaginal discharge was tested with
nitrazine and found to have a pH around 5. Other then the findings from
the speculum exam, the patient’s physical portion of the visit was benign
(i.e. no CVA tenderness or abdominal pain). The patient’s symptoms and
findings from the wet mount led to a diagnosis of bacterial vaginosis.
Treatment
For pregnant women the CDC recommends metronidazole 500 mg orally twice a
day for 7 days, metronidazole 250 mg orally three times a day for 7 days
or clindamycin 300 mg orally twice a day for 7 days. The patient was
prescribed metronidazole 500 mg orally twice a day for 7 days. Patient
teaching included abstaining from sexual intercourse until completion of
treatment, avoiding alcohol (because it interacts with the drug), wearing
cotton underwear and avoiding restrictive clothing. The patient was also
asked to let the practitioner know if symptoms came back or did not
resolve at all.
Outcome
There was no test of cure done on this patient as the CDC does not
recommend this. At the return prenatal visit the patient reported that the
symptoms that she had initially been experiencing (itching, burning
discharge) had resolved following treatment.
Case created by Brenda Baffour, 2010.