Step 1: View clinicals

A 23 year old woman presents with a foul smelling vaginal discharge and mild vulvar itching for three weeks, which worsened during menstruation. There was no lower abdominal pain or fever. She engages in unprotected sex with a single, regular partner. Their last encounter was a week ago. She is currently on the combined oral contraceptive pill (COCP). Her medical history is unremarkable.

Step 2: Order all relevant investigations

Whiff Test

Application of potassium hydroxide (KOH) yields an amine odor.

Wet Mount Microscopy

Microscopy shows motile flagellated organisms and multiple leukocytes. No clue cells are seen.

CT Abdomen

The CT scan of the abdomen appears normal.

Gram Stain

The gram stain shows multiple flagellated organisms and leukocytes. No intracellular diplococci are noted.

Step 3: Select appropriate management

Screen Partner
Oral Metronidazole
Topical Antibiotics
Salt Water Bath

Score: ★★☆