1. Why the patient complaining about vaginal discharge with fishy odor in 2 weeks?

Adanya gadnerella yang mengubah asam amino menjadi amin yang menyebabkan
ph meningkat sehingga menyebabkan bau amis.
2. Why the speculum examination reveals a homogenous , white vaginal discharge and
fishy odor?
Lactobacillus merupakan flora normal yang menghasilkan H2O2. Dimana laktobacillus
berfungsi untuk membuat epitel vagina dan vulva dalam kondisi asam dengan
memetabolisme glikogen menjadi asam laktat. Suasana asam menyebabkan bakteri
patogen susah untuk menginvasi epitel pada vagina dan vulva
3. What is the etiology from the scenario?
- Trikomonas vaginalis
4. Explain about the pathophysiology of the disease!
5. Mention the clinical manifestation from the scenario!

Fishy Gray, fishy smelling vaginal discharge that is worse after having sex or washing
discharge with soap. There may also be itchiness or irritation in and around the vulva and
vagina. You may have bacterial vaginosis, see vaginitis.

Greenish Gray/greenish discharge as well as itchiness around the vagina or vulva. There
discharge may be a burning sensation when urinating and discomfort during sex. You
could havetrichomoniasis, a type of vaginitis which is sexually transmitted. Ask
your doctor to perform an STD test. Trichomonas is treated with antibiotics;
your partner will also need to be tested.

Cottage Thick white discharge which looks like cottage cheese, may smell yeasty like
cheese bread. Usually accompanied by itching and a burning sensation when urinating.
discharge The vulva can also look swollen and sore. See: yeast infection
symptoms (Candida).

Watery Bleeding between periods with abnormal vaginal discharges. Discharge may be
discharge watery, pinkish, foul smelling or blood tinged. The vulva may be persistently
itchy (pruritus). Rule out: vaginal cancer symptoms.

Increased Bleeding between periods or heavier periods than normal with increased
vaginal vaginal discharge. There may be a burning feeling in the vagina and urethra
discharge which could be mistaken for a urinary tract infection (cystitis). There may also
be irritation around the anus and a need to urinate frequently. These are
symptoms of gonorrhea, a sexually transmitted disease.
 Discharge Unusual vaginal discharge, burning pain when urinating, lower abdominal pain
with burning and a frequent need to urinate; these are all signs of a sexually transmitted
pain disease calledchlamydia. Sometimes there may be no symptoms. Ask your
doctor for a chlamydia screening. Treatment consists of antibiotics with a
follow up test a few weeks later. Your partner will also need to be tested.

6. What are the DD of the scenario!

7. What are the risk factor of the scenario!

Causes And Risk Factors

There are numerous possible causes for vaginal odor. Some of these causes include:

 Bacterial vaginosis: This is the most common cause of vaginal odor. This condition
occurs when there is an overgrowth of normally occurring vaginal bacteria. Women with
bacterial vaginosis may notice other symptoms besides vaginal odor, such as vaginal
itching, a thin, grayish vaginal discharge, pain during intercourse or a burning sensation
when urinating.
 Sexually transmitted diseases: A few STDs can lead to vaginal odor, including
Chlamydia, trichomoniasis and gonorrhea.
 Tampons: When a tampon is retained for too long or forgotten about after being inserted,
vaginal odor may result. It’s critical that women not let this happen since leaving a
tampon in for too long may also result in toxic shock syndrome (TSS), which can be
fatal.
 Pelvic inflammatory disease: Also referred to as simply PID, this condition occurs
when sexually transmitted bacteria travels from the vagina to the uterus and the upper
genital tract. Other symptoms besides vaginal odor may include pain in the lower
abdomen, irregular menstrual bleeding, painful urination, heavy vaginal discharge, fever,
fatigue, diarrhea and vomiting.
 Poor hygiene: Women who practice poor hygiene may find that they experience vaginal
odor. In addition to preventing vaginal odor, good hygiene is also helpful for preventing
urinary tract infections.
 Yeast infection:This is a relatively common condition among women – about 3 out of 4
women experience a yeast infection at some point. Yeast infections are caused by an
imbalance in the levels of yeast and bacteria in the vagina. Other common symptoms
include vaginal itching, vaginal burning, redness and swelling of the vulva and a thick,
white discharge with a cottage cheese appearance.
 Rectovaginal fistula: One of the less common causes of vaginal odor is a rectovaginal
fistula, which is an abnormal opening between the rectum and vagina. This opening may
allow the contents of the bowels to leak into the vagina or allow stool, pus or gas to pass
from the vagina. Other symptoms include irritation or pain in the vaginal area, recurrent
vaginal or urinary tract infections or pain during intercourse. Most rectovaginal fistulas
have to be repaired surgically.
 Cancer: Vaginal cancer and cervical cancer may both cause vaginal odor. These are
much less common causes of vaginal odor compared to the other causes listed above.

8. What are the supporting examination of the scenario!

9. What are the treatment for the disease in the scenario!

10. Explain about the physical examination associated to the scenario!

11. What are the complication for the disease in the scenario?