Case Study 2: Abnormal Vaginal Discharge
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Moderator: Dr John Paul
The Problem: Hermione is 18 years and works in a pet shop in Croydon. She had come to
me complaining of abnormal vaginal discharge. She also said that it had a fishy offensive
odor. Hermione has had no other problems for the past 10 month., The only medication
that she was taking was a combined oral contraceptive pill.
Dr. Helena: We are using telemedicine consulting to help Hermione. Comment, Chantal,
what do you think.
Dr. Fourier: Paul had sent me the reports of the various tests conducted to rule out
sexually transmitted infections and STDs. You also have the reports I think?
Dr Paul: Speculum examination was done on Hermione and a grayish white discharge was
found on the vaginal walls, but there was not cervical bleeding or polyps or fistulae.
Dr Helena: John, are you sure that the report for Trichomonas vaginalis, Chlamydia
trachomatis and Neisseria gonorrhoeae is negative? You have the reports and you too
Chantal?
Dr. Chantal: Bacterial Vaginosis is the likely diagnosis. This is the most common cause of
abnormal vaginal discharge in women of childbearing age and is characterized by an
overgrowth of predominantly anaerobic organisms, leading to a replacement of lactobacilli
and an increase in vaginal pH.
Dr . Helena: I agree and I suggest the following therapy options: Metronidazole 2g as a
single dose, or metronidazole 400mg twice a day for seven days. Topical treatments
(intravaginal metronidazole gel or intravaginal clindamycin cream) can be used if the
patient cannot tolerate oral metronidazole, but can be more expensive options.
Dr Paul and Dr Chantal: We concur with Helena. Hermione should be advised to avoid
vaginal douching, washing the genitals with shower gels or soaps and adding antiseptics
to the bath,.
Hermione: Thanks Dr Paul, and you too, Dr Chantal and Dr Helena for helping me out.
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