White Cottage Cheese-Like Discharge
31-year -old Caucasian female born 11/19/1985. She was born and raised in Murfreesboro, TN. She works part-time as a social worker and spends the rest of her day at home with her 3-year-old son. She is happily married to her husband of 8 years.
Reason for Seeking Care/Chief Complaint: “I am having white, cottage cheese-like discharge and it hurts to pee”
History of Present Illness:
Patient presents to the clinic with complaints of having a constant white, cottage cheese-like vaginal discharge. She states she has associated symptoms such has vaginal itching and dysuria. Patient admits she gets bacterial and yeast infections easily, especially if her husband does not perform proper genital hygiene before intercourse. She denies having intercourse since symptoms started. Patient denies fever, chills, nausea, vomiting, pelvic pain, urinary urgency or frequency and hematuria. She also denies vaginal bleeding, genital lesions, erythema and irregular menses. Patient states she has not tried taking any over-the-counter creams or ointments to relieve symptoms as they “have never worked” in the past, but did try to douche because she thought it was “worth a shot” to make the discharge “go away” however, it did not improve symptoms. Patient also denies changing laundry soaps, fabric softeners or body soaps. She states she does wear …show more content…
tight fitting clothing, such as spandex pants to workout in and panty hose under skirts for professional work attire.
Past Medical History:
accidental/injuries: none illnesses (chronic): asthma (mild, intermittent)
hospitalizations: childbirth surgeries: none Obstetric/Gynecologic history:
Gravida 1, Para 1; denies abortions; LMP 2 weeks ago; age of menarche- 12 y/o; reports regular menstrual cycle with a light to moderate flow that lasts 3-4 days; patient uses tampons; denies history of STI’s, but has history of both bacterial vaginosis and vaginal candidiasis, with the last one being bacterial vaginosis 6 months ago and was treated with antibiotics that relieved symptoms.
Sexual history: total of 3 male partners, first encounter beginning at the age of 15; patient is currently having unprotected vaginal and oral sex with one male partner (spouse); patient states she has intercourse with her spouse 3-4 times a week. She is currently taking oral contraceptive pills and is both satisfied and compliant with regimen. Patient has had one vaginal delivery without complications. Patient tried douching for the first time this week. Patient states she wearing tight fitting clothing and undergarments on a regular basis. Denies taking bubble baths or having genital piercings.
Last exams:
Physical: 21-years- old
Dental: 6 months ago
Vision: 1 year ago
Hearing: reports none
ECG: reports none
CXR: reports none
Immunizations- up-to-date
Allergies:
Seasonal allergies to pollen
Denies allergies to medication
Denies seasonal allergies Current Medications:
SABA PRN acetaminophen PRN for fever or pain
Denies using supplements or herbs Family History:
Mother: HLD, headaches, depression, anxiety, current smoker
Maternal Grandmother: DM, diabetic neuropathy, glaucoma
Maternal Grandfather: deceased from heart attack (age 65, 1995)
Maternal Aunt: deceased from breast cancer (age 42, 1998)
Father: HTN, HLD,
Paternal Grandmother: DM, HLD
Paternal Grandfather: unknown
Review of Systems:
General: denies fever, chills, body aches, nausea, vomiting, diarrhea and fatigue
CV: Patient denies chest pain, palpitations, dyspnea, orthopnea, or exercise intolerance. Resp: Patient denies dyspnea, wheezing, cough, hemoptysis, or night sweats.
GI: Patient denies abdominal pain, nausea, diarrhea or constipation
GU: Patient states she had dysuria, but denies hematuria, urgency or frequency. She also denies difficulty starting or stopping urination, foul odor, or change in consistency of urine such as dark or cloudy.
Reproductive: Patient states she has white, thick vaginal discharge with pruritus. Patient denies genital lesions, external vaginal erythema or abnormal vaginal bleeding.
Questions:
1. Are you experiencing painful intercourse? “Before my symptoms started, I did not experience painful sex.” “I have had infections like this in the past, so I know better than to have sex before I am treated with an antibiotic.”
2. Are you bleeding during intercourse? “I mean… I have spotted during sex before, if I am about to start my period, but nothing that I am concerned about.”
3. What type of hygiene regimen do you and your husband have before and after intercourse? “I know that I easily get vaginal infections, so I try to make sure my husband cleans his penis before we have sex. We go through phases that we forget or simply don’t want to take the time to do it. After intercourse, I use the restroom and wipe front to back.”
4. Are you experiencing pain your back? “No”
5. Has your husband ever been treated for a sexually transmitted infection? “I think he was treated with chlamydia once when he was in his younger twenties, way before he met me.”
Functional Assessment:
Patient reports ability to perform all activities of daily living independently.
This includes dressing, grooming, bathing, cooking, cleaning and driving. Patient states she primarily does all the grocery shopping, meal prepping and takes care of the finances. She enjoys eating healthy and exercises as often as she can. She states her exercise of choice is running and kickboxing. Patient reports she enjoys playing outside with her son, reading him books and participating in community activities for his age group. She attends a local Baptist church with her husband and wants to start participating in a weekly bible study for married
couples.
Reason for Seeking Care/Chief Complaint: “I am having white, cottage cheese-like discharge and it hurts to pee”
History of Present Illness:
Patient presents to the clinic with complaints of having a constant white, cottage cheese-like vaginal discharge. She states she has associated symptoms such has vaginal itching and dysuria. Patient admits she gets bacterial and yeast infections easily, especially if her husband does not perform proper genital hygiene before intercourse. She denies having intercourse since symptoms started. Patient denies fever, chills, nausea, vomiting, pelvic pain, urinary urgency or frequency and hematuria. She also denies vaginal bleeding, genital lesions, erythema and irregular menses. Patient states she has not tried taking any over-the-counter creams or ointments to relieve symptoms as they “have never worked” in the past, but did try to douche because she thought it was “worth a shot” to make the discharge “go away” however, it did not improve symptoms. Patient also denies changing laundry soaps, fabric softeners or body soaps. She states she does wear …show more content…
tight fitting clothing, such as spandex pants to workout in and panty hose under skirts for professional work attire.
Past Medical History:
accidental/injuries: none illnesses (chronic): asthma (mild, intermittent)
hospitalizations: childbirth surgeries: none Obstetric/Gynecologic history:
Gravida 1, Para 1; denies abortions; LMP 2 weeks ago; age of menarche- 12 y/o; reports regular menstrual cycle with a light to moderate flow that lasts 3-4 days; patient uses tampons; denies history of STI’s, but has history of both bacterial vaginosis and vaginal candidiasis, with the last one being bacterial vaginosis 6 months ago and was treated with antibiotics that relieved symptoms.
Sexual history: total of 3 male partners, first encounter beginning at the age of 15; patient is currently having unprotected vaginal and oral sex with one male partner (spouse); patient states she has intercourse with her spouse 3-4 times a week. She is currently taking oral contraceptive pills and is both satisfied and compliant with regimen. Patient has had one vaginal delivery without complications. Patient tried douching for the first time this week. Patient states she wearing tight fitting clothing and undergarments on a regular basis. Denies taking bubble baths or having genital piercings.
Last exams:
Physical: 21-years- old
Dental: 6 months ago
Vision: 1 year ago
Hearing: reports none
ECG: reports none
CXR: reports none
Immunizations- up-to-date
Allergies:
Seasonal allergies to pollen
Denies allergies to medication
Denies seasonal allergies Current Medications:
SABA PRN acetaminophen PRN for fever or pain
Denies using supplements or herbs Family History:
Mother: HLD, headaches, depression, anxiety, current smoker
Maternal Grandmother: DM, diabetic neuropathy, glaucoma
Maternal Grandfather: deceased from heart attack (age 65, 1995)
Maternal Aunt: deceased from breast cancer (age 42, 1998)
Father: HTN, HLD,
Paternal Grandmother: DM, HLD
Paternal Grandfather: unknown
Review of Systems:
General: denies fever, chills, body aches, nausea, vomiting, diarrhea and fatigue
CV: Patient denies chest pain, palpitations, dyspnea, orthopnea, or exercise intolerance. Resp: Patient denies dyspnea, wheezing, cough, hemoptysis, or night sweats.
GI: Patient denies abdominal pain, nausea, diarrhea or constipation
GU: Patient states she had dysuria, but denies hematuria, urgency or frequency. She also denies difficulty starting or stopping urination, foul odor, or change in consistency of urine such as dark or cloudy.
Reproductive: Patient states she has white, thick vaginal discharge with pruritus. Patient denies genital lesions, external vaginal erythema or abnormal vaginal bleeding.
Questions:
1. Are you experiencing painful intercourse? “Before my symptoms started, I did not experience painful sex.” “I have had infections like this in the past, so I know better than to have sex before I am treated with an antibiotic.”
2. Are you bleeding during intercourse? “I mean… I have spotted during sex before, if I am about to start my period, but nothing that I am concerned about.”
3. What type of hygiene regimen do you and your husband have before and after intercourse? “I know that I easily get vaginal infections, so I try to make sure my husband cleans his penis before we have sex. We go through phases that we forget or simply don’t want to take the time to do it. After intercourse, I use the restroom and wipe front to back.”
4. Are you experiencing pain your back? “No”
5. Has your husband ever been treated for a sexually transmitted infection? “I think he was treated with chlamydia once when he was in his younger twenties, way before he met me.”
Functional Assessment:
Patient reports ability to perform all activities of daily living independently.
This includes dressing, grooming, bathing, cooking, cleaning and driving. Patient states she primarily does all the grocery shopping, meal prepping and takes care of the finances. She enjoys eating healthy and exercises as often as she can. She states her exercise of choice is running and kickboxing. Patient reports she enjoys playing outside with her son, reading him books and participating in community activities for his age group. She attends a local Baptist church with her husband and wants to start participating in a weekly bible study for married
couples.