Snapshot A 26-year-old woman presents to her primary care physician due to a foul smelling vaginal discharge. She reports that this is the first time this occurred. She describes the discharge as off-white with a "fish-like" odor. She denies any pain during sexual intercourse, post-coital bleeding, burning, or pruritus. She has a new sexual partner where she consistently uses condoms. She reports to recently practicing vaginal douching. On physical exam, the vulva appears normal. Speculum examination demonstrates an off-white to gray vaginal discharge and a normal cervix. Vaginal pH is 5.5. An amine test is positive. Saline microscopy demonstrates clue cells within the vaginal epithelium. Introduction Clinical definition login to view 4 more bullets Epidemiology login to view 12 more bullets Etiology login to view 4 more bullets Pathobiology login to view 15 more bullets Prognosis login to view 6 more bullets Presentation Vaginitis Vaginitis Etiology Clinical Presentation Bacterial vaginosis Gardnerella vaginalis Symptoms malodorous ("fishy" odor) vaginal discharge nonpainful Physical exam off-white or gray and thin vaginal discharge normal vulva Vulvovaginal candidiasis Candida albicans Symptoms pruritus and soreness dyspareunia Physical exam thick, white, odorless, and curd-like vaginal discharge vulvar erythema and edema Trichomoniasis Trichomonas vaginalis Symptoms malodorous greenish discharge burning dyspareunia and dysuria postcoital bleeding Physical exam malodorous discharge "strawberry" cervix vulvovaginal erythema Important note sexually transmitted; therefore, the partner must also be treated Studies Management approach login to view 4 more bullets Speculum exam login to view 24 more bullets Differential Atrophic vaginitis login to view 6 more bullets Treatment Medical login to view 15 more bullets Complications Bacterial vaginosis login to view 6 more bullets Trichomoniasis login to view 2 more bullets Vulvovaginal candidiasis login to view 4 more bullets