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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify predisposing factors associated with bacterial vaginosis.

  • List the common clinical and diagnostic findings associated with bacterial vaginosis.

  • Develop a therapeutic plan for the management of bacterial vaginosis.

  • Describe the role of the pharmacist in the overall management of infectious vaginitis.

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PATIENT PRESENTATION

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Chief Complaint

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“I think I might have a yeast infection.”

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HPI

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Judy Heyman is a 30-year-old female graduate student who comes to the Family Practice Center for an acute visit. She states that 1 month ago she was seen at an urgent care center for severe facial pain and headache. She was diagnosed with an acute sinus infection and given a prescription for a 2-week course of doxycycline (100 mg PO BID). During treatment, she developed a vaginal yeast infection. She self-treated it with a nonprescription antifungal cream that alleviated her symptoms. She states that she completed her course of doxycycline despite some mild diarrhea attributed to the drug. Presently, she complains of some mild vaginal discomfort (worse with intercourse) and a “fishy” vaginal odor. Her last period was approximately 5 weeks ago. She admits to inconsistent use of a diaphragm and foam for contraception.

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PMH

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  • Venereal warts—2011

  • GERD

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FH

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Noncontributory

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SH

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Is a graduate student in the College of Business and Economics. Has multiple sexual partners (including women); male partners rarely use condoms. Has smoked one pack of cigarettes per day since age 16. Alcohol use consists of a glass of wine nightly and occasional beer. Smokes an occasional marijuana joint.

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Meds

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  • Prilosec 20 mg PO Q HS

  • Multivitamin one PO daily

  • Calcium supplement with vitamin D one PO daily

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All

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Cats → itchy eyes and sneezing; house dust → watery eyes, sneezing; penicillin → hive-like pruritic rash, some tightness in her chest; topical clindamycin → facial rash when used to treat acne 15 years ago.

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ROS

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Noncontributory except that she has noticed a small amount of thin, white mucus on her underclothing and her period is approximately 7 days late

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Physical Examination

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Limited because of acute visit for specific gynecologic complaint

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Gen
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Patient is a healthy-appearing 30-year-old woman in NAD

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VS
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BP 130/75 mm Hg, P 90 bpm, RR 16, T 37.4°C; Wt 51.5 kg, Ht 5′3″

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Genit/Rect
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External genitalia WNL; no discharge expressed from the urethra, vagina with a small amount of thin white mucus; positive “whiff” test; pH 5.0. Cervix—not completely visualized; appears clear with ...

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