Assessment

HISTORY. Elicit a history of the onset and description of symptoms, with particular attention to the nature and amount of vaginal discharge, which may be frothy, thick, or malodorous. Question the patient to determine if she is experiencing discomfort such as external inflammation and pain, and pruritus. Patients may describe exertional dysuria, dyspareunia, and vulvular inflammation. Determine the medications that the patient is taking, with particular attention to antibiotics, hormone replacement therapy, and contraceptives. Take a menstrual history. Ask about the patient's rest, sleep, nutrition, exercise, and hygiene practices. Ask the patient if she is pregnant or a diabetic, both of which place the patient at risk for vaginitis.

PHYSICAL EXAMINATION. Vaginal examination should take place under the following conditions: not on menses; no douching or vaginal sprays for 24 hours prior to exam; no sexual intercourse without a condom for 24 hours prior to the exam. Physical examination generally reveals some type of discharge, such as frothy, malodorous, greenish-yellow, purulent vaginal discharge (trichomoniasis); thick, cottage cheese-like discharge (candidiasis); or malodorous, thin, grayish-white, foul, fishy odor discharge (bacterial). The external and internal genitalia are often reddened, inflamed, and painful on examination. Women with candidiasis often have patches on vaginal walls and cervix and signs of inflammation. Women with trichomoniasis have a strawberry spot on the vaginal surface and cervix. Bacterial vaginitis is often asymptomatic with a normal vaginal mucosa. Palpate the patient's abdomen for tenderness or pain, which may indicate pelvic inflammatory disease.

PSYCHOSOCIAL. Psychosocial assessment should include evaluation of the patient's home situation and a sexual history. Ask the patient about the type of contraception she and her partner use. Provide a private environment to allow the patient to answer questions without being embarrassed.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Saline wet mount

Negative for organ

Positive for organism (visualized

Identifies the

(wet prep)

ism (not visualized

under microscope); clue cells

organism

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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