A patient having pruritus and white discharge, which would be seen?

NORCET 5 Prelims - Sept 2023 (Shift-1)

Obstetrics & Gynaecology

Easy

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

The patient's symptoms of pruritus (itching) and white discharge are the hallmark presentation of vulvovaginal candidiasis.
This infection is caused by an overgrowth of the fungus Candida albicans.
The discharge in candidiasis is classically described as thick, white, curdy, or 'cottage cheese-like' and is associated with significant vulvar itching and irritation.
The vaginal pH in candidiasis is typically normal (less than 4.5).

Option A: Trichomoniasis typically causes a frothy, yellow-green, and malodorous (foul-smelling) discharge, which is different from the white discharge described.
Option C: E. coli is a primary cause of urinary tract infections (UTIs) and is an uncommon cause of vaginitis. When it does cause vaginitis (aerobic vaginitis), the discharge is typically purulent and watery, not white and curdy.
Option D: Gonorrhea, a sexually transmitted infection, typically causes a mucopurulent (pus-like) discharge originating from the cervix, which may appear yellowish. It does not cause a white, curdy discharge.

Visual 1: Chart - A comparative table showing the characteristics (color, consistency, odor, pH) of discharge from Candida, Trichomoniasis, Bacterial Vaginosis, and Gonorrhea.
Visual 2: Microscopic Image - A potassium hydroxide (KOH) prep slide showing the pseudohyphae and budding yeast forms of Candida albicans.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of infectious vaginitis based on clinical signs and symptoms to guide bedside assessment, documentation, and the next nursing action.
Accurate diagnosis is critical because the treatments are different: candidiasis requires antifungals, while trichomoniasis and gonorrhea require antimicrobials (antiprotozoal and antibiotic, respectively).
Nurses should educate patients on risk factors for candidiasis, such as recent antibiotic therapy, uncontrolled diabetes, pregnancy, and immunosuppression.
Patient education should include perineal hygiene (wiping front to back), wearing cotton underwear, and avoiding douching, which can disrupt the normal vaginal flora.

How to Approach the Question

First, identify the key clinical signs presented in the question: pruritus (itching) and white discharge.
Next, systematically review the options provided and recall the classic presentation of each condition.
For Option A (Trichomoniasis), recall its characteristic frothy, yellow-green, malodorous discharge.
For Option B (Candida), recall its classic thick, white, curdy discharge accompanied by intense itching.
For Option C (E-coli), recognize it as a primary cause of UTIs, not typically vaginitis with these symptoms.
For Option D (Gonorrhea), remember it causes a purulent, yellowish cervical discharge.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of infectious vaginitis based on clinical signs and symptoms.
Stem keywords: pruritus, white discharge
Lead-in keywords: which would be seen
Clinical cues: The combination of itching (pruritus) and white discharge is a classic pairing for a specific type of infection.

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