New England Training Curriculum in
Sexually Transmitted Infections

A CME-based series of online case studies

Case 4

A 20-year-old female presents with complaints of vaginal itching and irritation for the past three days. Two weeks ago, she had streptococcal pharyngitis and was treated with amoxicillin. For the last year, she has had one male sex partner and she reports that they consistently use condoms. Pelvic examination reveals erythema of the vulva and vagina and the presence of a thick, whitish vaginal discharge. The pH of the discharge is 4.0.

Begin quiz

QUESTION 1: What is the most likely diagnosis in this patient?*
- A: Herpes Simplex Virus (HSV)
- B: Pelvic inflammatory disease
- C: Syphilis
- D: Bacterial Vaginosis

Question 2: Which of the following tests should be ordered/performed?*
- A: CBC, vaginal saline wet mount and “whiff test”
- B: Pregnancy test, NAAT testing for chlamydia and gonorrhea
- C: KOH wet mount and pregnancy test
- D: Vaginal saline wet mount, KOH wet mount, “whiff test”, vaginal pH, NAAT testing for chlamydia and gonorrhea

Question 3: What is the recommended first-line treatment for this patient?*
- A: Azithromycin 1 gram orally once
- B : Metronidazole 1 gram orally once
- C: Metronidazole 500 mg orally twice a day for 7 days
- D: Doxycycline 100 mg orally twice a day for 7 days
- E: Ceftriaxone 250 mg intramuscular in a single dose and azithromycin 1 gram, orally in a single dose

Question 4: The patient presents with persistent symptoms of BV which are confirmed by clinical criteria. What is the recommended approach for this patient?*
- A: Retreatment with the same initial regimen
- B: Use of a different recommended regimen
- C: Supportive care only
- D: Intravaginal lactobacillus formulations
- E: A or B

Question 5: Which of the following regarding BV is true?*
- A: Treatment of the male partner will reduce likelihood of re-infection
- B: For symptom relief, douching is encouraged
- C: Recurrent infection likely indicates resistance to treatment
- D: BV is more common in HIV positive women
- E: Pregnant women with symptomatic BV should not be treated
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Funded by the U.S. Department of Health and Human Services, Health Resources & Services Administration
HIV/AIDS Bureau, under grant number, U1OHA29294.

New England Training Curriculum inSexually Transmitted Infections

A CME-based series of online case studies

Case 4

New England Training Curriculum in
Sexually Transmitted Infections