Vaginal discharge in a young woman.

Volume 89, Number 11 www.aafp.org/afp American Family Physician 905 A 22-year-old woman presented with malodorous vaginal discharge and soreness that began one week earlier. She had dyspareunia, but no itching, dysuria, or lower abdominal pain. She was not douching or using any local intravaginal chemical treatment. She had multiple sex partners and had chlamydia infection twice within the previous year. She had one pregnancy, which was uncomplicated. Examination of the vulva was unremarkable. Speculum examination of the vagina revealed multiple small, erythematous macules covering the vaginal wall and ectocervix (see accompanying figure), and a moderate amount of homogeneous yellowish discharge. Microscopic examination of the vaginal secretions with saline showed a motile organism and an excessive number of leukocytes. Results of a potassium hydroxide preparation and rapid testing for chlamydia, gonorrhea, and human immunodeficiency virus infections were negative.