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An 18-year-old female presented to her physician with vulvar and vaginal itching associated with a vaginal discharge. On examination, the patient is noted to have redness and excoriations on her vulva (Figure 74-1). She also had a thick white discharge was seen covering cervix and vaginal sidewallson speculum exam. The pH of the discharge was 4.2, and <10 percent of the epithelial cells on her wet prep were clue cells (Figure 74-2), but yeast and hyphae were noted. She was diagnosed with candida vulvovaginitis and was treated with oral fluconazole.
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Vaginal discharge is a frequent presenting complaint in primary care. The three most common causes in adolescents and adults are bacterial vaginosis, candidiasis, and trichomoniasis. Providers must refrain from “diagnosing” a vaginitis based solely on the color and consistency of the discharge, as this may lead to misdiagnosis and may miss concomitant infections.1
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Vulvovaginal complaints in prepubertal children may be result from infection, congenital abnormalities, trauma, or dermatologic conditions. Vaginitis is the most commont gynecologic problem in prepubertal girls, often presenting with symptoms including vaginal discharge, erythema, soreness, pruritus, dysuria, or bleeding.2
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Adolescence is a developmental period with rapid changes in physical characteristics, sexual development, emotional development, and sexual activity. These changes may result in potential increased risk for acquiring sexually transmitted diseases.
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The reported rates of chlamydia and gonorrhea are highest among females ages 15 to 19 years. Adolescents are at greater risk for sexually transmitted diseases (STDs) because they frequently have unprotected intercourse, are biologically more susceptible to infection, are often engaged in partnerships of limited duration, and face multiple obstacles to utilization of health care.1
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Cross-sectional data from the 2003 to 2004 US National Health and Nutrition Examination Survey (NHANES) shows 24 percent of female adolescents (aged 14 to 19 years) had laboratory evidence of infection with human papillomavirus (HPV, 18%), Chlamydia ...