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According to Dains, Baumann, & Scheibel (2015), a fishy odor is caused by amines released from organic acids which occurs with Bacterial vaginosis. The two further tests that I would order are the “whiff” test and a vaginal pH test (Dains, Baumann, & Scheibel, 2015). The “whiff” test is positive if the smell is accentuated when adding potassium hydroxide to the wet mound slide (Dains, Baumann, & Scheibel, 2015). The vaginal pH test would also be important in confirming the diagnosis. A pH of 4.5 or high is a sign of bacterial vaginosis (Mayo Clinic, 2018). This odor can also be present with a trichomonal infection or retained items in the vagina (Dains, Baumann, & Scheibel, 2015). Due to these circumstances a vaginal exam and an STD test may be useful for differential diagnoses.
Dains, J. E., Baumann, L. C. & Scheibel, (2015). Advanced Health Assessment and Clinical Diagnosis in Primary Care. (5th Ed.). St. Louis, MO: Elsevier. ISBN: 981-1-60913-762-5
Mayo Clinic (2018). Bacterial vaginosis. Retrieved from: https://www.mayoclinic.org.diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285
Bacterial vaginosis (BV) is a common condition that is characterized by the presence of abnormal discharged caused by an overgrowth or imbalance of atypical bacterial that is normally present in the vagina. Risk factors for developing BV include having multiple sex partners, and douching (CDC, 2018). Although there has been a link to BV and having multiple sexual partners this is not necessarily the case in many situations making research on how BV is spread ongoing.
Regarding diagnosis, your health care practitioner will perform a pelvic exam inspecting for signs of vaginal discharge they can also perform laboratory tests on the sample of vaginal fluid to determine if BV is present (CDC, 2018). Many time BV can resolve on its own but can also be treated with antibiotics although it may recur in some cases. Not only is treatment important in providing relief from the discomfort of odor, itching, and discharge but it can also reduce the risk of getting other sexually transmitted diseases such as gonorrhea, chlamydia, and HIV. Tests used to diagnose BV start with a pelvic exam followed by sampling of vaginal secretions which will contain what is known as clue cells which are vaginal squamous cells coated with anaerobic gram variable coccobacilli as well as checking for secretion pH of 4.5 or greater. These findings would all coincide with the diagnosis of BV.
Preparing for a vaginal exam includes educating the patient on the procedure details. The patient should be educated on the importance of detection and treatment as it relates to the inspection of the vaginal area. Preparation instructions involve that the patient wear comfortable loose-fitting clothing. Explanation of the use of a speculum, swabs, or other collection devices and microscopic assessment to look for clue cells on the smear which uses Gram stain to detect the shift of normal vaginal flora to other microorganisms should be discussed. Making sure that the patients privacy, and comfort are maintained is important during this procedure as well as reassurance that it is a common finding that has resolution.
Center for Disease Control and Prevention (2018) Retrieved from https://www.cdc.gov/std/bv/stdfact-bacterial-vagin…
Parma, M., M.D., Vanni, V. S., M.D., Bertini, M., M.D., & Candiani, M., M.D. (2014). Probiotics in the prevention of recurrences of bacterial vaginosis. Alternative Therapies in Health and Medicine, 20, 52-7. Retrieved from https://prx-herzing.lirn.net/login?url=https://sea…