Case No. 70

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Case No. 70


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Chief Complaint:

Vaginal discharge and dysuria

Published: Aug. 7, 2017
Author: venuscv

A previously healthy 23-year-old female presents to a primary care office for evaluation of 1-week history of vaginal discharge. She describes the discharge as "white-yellow" and associated with itch and deep dyspareunia. When asked about urinary symptoms, she pauses for a moment and then admits there has been some "burning when I pee". She denies any recent fevers, surgery, travel, pelvic pain, and ocular symptoms. Upon further evaluation of her sexual history, the patient has had multiple partners in the past month with inconsistent barrier protection. She does not use any other method of contraception. On examination, the patient appears well and is afebrile. Her vital signs are: BP 110/70, HR 80 bpm and regular, lung sounds are clear with air entry equal bilaterally. Her oral exam is unremarkable and there is no evidence of pharyngeal discharge. Cardiovascular sounds reveal normal S1/S2 with no murmurs. Her abdomen and pelvis is soft, non-tender, demonstrating no palpable masses. There is no evidence of rash on her body.


What is the next best study?

  • Speculum examination including cervical/vaginal swabs for gonorrhea and chlamydia
  • Bimanual examination to rule out cervical motion tenderness
  • First-catch urine nucleic acid amplification test (NAAT)
  • Self-collected vaginal swab NAAT test
  • Options C and D
  • All of the above
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