Mary, a 32-year-old, G0P0, female who identifies as lesbian, presents with c/o vaginal discharge
that has a strong fishy odor. She has tried douching and over-the-counter remedies with no relief.
She shares that she and her girlfriend use sex toys. She denies having sex with anyone else, but
she says her girlfriend is bisexual and possibly has been with someone else. She says she has
only had one pelvic exam when she was 20 years old, with a male physician, and she felt as
though she had been raped. During the examination, he was rough and she could tell he did not
like the fact that she identified as lesbian. She has not been seen since. She denies any health
issues in her past, has never been pregnant, has never had sex with males, and has never had an
STI, or at least she believes she has not. She also shares that she is very nervous but knew she
had to come in.

1. Prior to your exam, how will you address her fear?
2. What other historical information will you obtain?
   On exam, her height is 5′ 8″, weight 165lbs, BP 118/76, breast exam negative, pelvic exam
   reveals thin homogenous, frothy green discharge pooling in the posterior fornix. Negative
   cervical motion tenderness, negative adnexal tenderness, and her uterus is normal size, shape,
   and contour with no tenderness on palpation. Her cervix is normal but bleeds easily with
   manipulation.
3. What are your differential diagnoses? What is your final diagnosis?
4. What additional tests will you order and why?
5. Based on your final diagnosis, what is your treatment plan?
6. What educational issues do you want to discuss with this patient.

Sample Solution