A 21-Year-Old Woman With Dysuria and Vaginal Discharge

Melanie Malloy, MD, PhD; Richard H. Sinert, DO

Disclosures

August 21, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 21-year-old woman presents to the emergency department with 3 days of abdominal pain and dysuria. She describes the pain as dull, aching, suprapubic pain radiating to the low back. She complains of frequency in urination and says that she is hesitant to urinate because she is afraid that it will be painful. She states that her urine has been "dark" over the past day.

The patient denies fever and chills, nausea, vomiting, and diarrhea but states that she has had an increase in vaginal discharge. She denies dyspareunia and vaginal itching. She recently began a relationship with a new male sexual partner and intermittently uses barrier contraception. She states that she has had eight sexual partners in her life and tested negative for HIV before starting this relationship. She is unsure whether her partner has been tested for any sexually transmitted infections (STIs).

The patient's last menstrual period was 3 weeks ago and was normal. Her periods have been regular and not painful or heavy. She has never been pregnant. Findings on her most recent Pap smear were normal. She has no history of STI or urinary tract infection (UTI). Her partner has not had penile discharge.

The patient has no significant medical history and has not had any surgeries in the past. She states that she is allergic to shellfish and reports that she uses alcohol on the weekends and smokes four to five cigarettes per day. She has taken oral contraceptive pills daily for the past 6 months.

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