Odorous vaginal discharge is a common presentation to general practitioners, and a frequent presentation for bacterial infections and sexually transmissible diseases. Busy GPs may be tempted to make a diagnosis from the clinical history and symptoms, and prescribe antibiotics as a first line treatment. This case highlights an unusual cause of persistent odorous vaginal discharge. If a thorough examination had not been conducted, the cause would have been overlooked, first line antibiotics would most likely have been ineffective, and potentially life threatening consequences may have occurred.
Debbie, a single mother, 27 years of age, presented with 3 weeks of persistent vaginal discharge. The discharge was foul smelling, light green, of moderate volume without any blood stain or clot. She also experienced moderate suprapubic pain that was constant and without radiation. The pain was exacerbated by bearing down and was not relieved by nonsteroidal anti-inflammatory drugs. She did not experience fever, dysuria or loin pain. She had an intrauterine device inserted 4 years ago which gave her irregular, light menses with cycles ranging from 48–60 days; she could not recall the exact date of her last menstrual period and was overdue for a Pap test. She was unemployed and lived with her father, taking care of two young children. She maintained an active sex life without a steady partner, and had unprotected intercourse 1 month ago with an unknown, casual partner. She believed her vaginal discharge was caused by a sexually transmissible infection (STI) from that sexual encounter. Consequently, Debbie requested blood tests to exclude an STI, and in the hope of finding a 'quick fix' treatment.
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