Presenting Complaints

• 43-year-old female presenting with 1 week of increased vaginal discharge.

History of Presenting Complaint

• Patient reports a thick, yellow-green vaginal discharge that has been present for the past 7 days.
• She describes the discharge as having a foul, fishy odor.
• She has also experienced mild vaginal itching and discomfort, but no significant pain.
• She denies any fever, chills, or other systemic symptoms.
• She had unprotected sexual intercourse with a new partner 2 weeks ago.
• She reports no history of similar vaginal discharge in the past.

Significant Positives & Negatives For Differentials

Bacterial Vaginosis

Positives:

• Thin, gray, foul-smelling vaginal discharge
• "Fishy" odor

Negatives:

• No history of similar episodes
• Recent antibiotic use (amoxicillin) may have disrupted normal vaginal flora

Vulvovaginal Candidiasis (Yeast Infection)

Positives:

• Thick, white, "cottage cheese-like" vaginal discharge
• Mild vaginal itching and irritation

Negatives:

• Lack of significant vaginal pain
• No history of similar episodes

Trichomoniasis

Positives:

• Frothy, yellow-green vaginal discharge with foul odor
• Recent unprotected sexual activity

Negatives:

• Lack of other associated symptoms like dysuria or pelvic pain

Gonorrhea or Chlamydia

Positives:

• Recent unprotected sexual activity

Negatives:

• Lack of other associated symptoms like dysuria or pelvic pain
• No history of sexually transmitted infections

Past Medical History

• Unremarkable, no prior gynecological issues.
• No history of sexually transmitted infections.

Drug/Medication History

• Takes a daily multivitamin, no other medications.
• Completed a course of amoxicillin 2 weeks ago for a sinus infection.

Social History

• Married, monogamous relationship.
• Works as an office administrator, no significant occupational exposures.
• Denies tobacco, alcohol, or illicit drug use.

Family History

• No family history of gynecological cancers or sexually transmitted infections.

Systems Review

• Negative for fever, chills, abdominal pain, dysuria, or other urinary symptoms.
• Negative for rashes, lesions, or other skin changes.

Ideas, Concerns & Expectations

• Patient is concerned she may have contracted a sexually transmitted infection from her new partner.
• She is worried the discharge may be a sign of a more serious condition.
• She expects the doctor to perform an examination and order appropriate tests to determine the cause of her symptoms.

Case Presentation

Based on the patient's presenting symptoms, medical history, and the significant positives and negatives for the differential diagnoses, the most likely diagnosis is either bacterial vaginosis or a yeast infection. The key features supporting these diagnoses are the thick, foul-smelling vaginal discharge, mild vaginal irritation, and lack of other associated symptoms. The recent antibiotic use may have also contributed to the development of a vaginal infection. Further examination and testing would be needed to differentiate between bacterial vaginosis and a yeast infection.