A 21-Year-Old Woman With Dysuria and Vaginal Discharge

Melanie Malloy, MD, PhD; Richard H. Sinert, DO

Disclosures

August 21, 2017

Physical Examination and Workup

The patient appears well but uncomfortable. Her heart rate is 88 beats/min, blood pressure is 115/72 mm Hg, temperature is 99.8° F orally, and respiratory rate is 15 breaths/min.

The patient's sclera are anicteric. Her heart has a normal first and second heart sound, with no murmurs, rubs, or gallops. Her lungs are clear to auscultation bilaterally. Her extremities are warm, with no rashes or lesions.

Upon abdominal examination, the abdomen is nondistended. Bowel sounds are normal. The patient has moderate suprapubic tenderness without rebound or guarding. She has no costovertebral angle tenderness bilaterally. She has no Murphy sign or McBurney point tenderness. No ecchymosis is noted.

Upon pelvic examination, the mons is shaved, with numerous small erythematous papules and scattered pustules. The vaginal walls are moist and pink, with no lesions. The patient has mild, thin, white cervical discharge that is not malodorous, without cervical erythema or friability (Figure 1). She has no cervical motion tenderness. The uterus is central, nontender, and not enlarged. The adnexa are nontender, and no masses are palpable. A urine sample is obtained (Figure 2) and sent for analysis.

Figure 1.

Figure 2.

A urine pregnancy test result was negative. Dipstick and microscopic analysis of the urine showed 5-10 white blood cells, 25 red blood cells, and few bacteria and was positive for leukocyte esterase and negative for nitrites.

Upon microscopic examination of the vaginal wet preparation, no trichomonads or clue cells are seen. No yeasts are seen on the potassium hydroxide preparation.

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