Case #4-Genitourinary A 28-year old presents complaining of 2 days of itchy vaginal discharge. One week ago you saw and treated her for a UTI with SMX-TMP. She completed her meds and developed vaginal discharge shortly thereafter. She denies abdominal pain and her dysuria has resolved. A pelvic exam reveals a thick, curd-like white discharge in her vagina that is adherent to the vaginal sidewalls. There is no cervical discharge.
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A 22-year-old woman presents at the walk-in health clinic with a slight fever (38.5°C), a complaint of frequent urination, burning on urination, vaginal discharge, and a small lesion on the labia. The woman reported that she was moderately sexually active and had three sexual partners in the past six months. Her last sexual contact was about 7 days earlier. She had developed mild symptoms about 5 days earlier, beginning with a discharge from the vagina. She began having pain on urination about 3 days earlier. Urine analysis revealed a pH of 8.2, some white cells, and a few red blood cells. There was protein in the urine. A smear of the vaginal secretion showed a number of Gram-negative cocci. Questions: 1. What is your diagnosis here? Explain the reasoning behind your choice. 2. What was the most likely organism? 3. Describe the mode of transmission. 4. Describe what clinical features are critical to your diagnosis. 5. What is the recommended treatment? 6. What further actions must be taken?
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