VAGINAL DISCHARGE

A   25-year-old woman   complains   of  a   whitish vaginal discharge.  She states

that    this    is  the first   time    she has this    complaint,  and it  is  associated  with

vaginal and vulvar  pruritus.   There   is  no  significant medical history,    and she

is  not on  oral    contraception.

Diagnostic Tests

Visual  inspection: The vulva   and vagina  should  be  examined    for evidence    of

an  inflammatory    response    as  well    as  the gross   characteristics of  the vaginal

discharge   seen    on  speculum    examination.

Vaginal pH: Normal  vaginal pH  is  an  acidic  <4.5.   Identification  of  the pH  is

easily  performed   using   pH-dependent    Nitrazine   paper.  Normal  vaginal

discharge   leaves  the paper   yellow, whereas an  elevated    pH  turns   the paper

dark.

Microscopic examination:    Two drops   of  the vaginal discharge   are placed  on

a   glass   slide   with    a   drop    of  normal  saline  placed  on  one,    and a   drop    of  KOH

placed  on  the other.  The two sites   are covered with    cover   slips   and examined

under   the microscope  for WBC,    pseudohyphae,   trichomonads,   and clue    cells.