A 36-year-old female presents with vaginal discharge but no significant itching or irritation. She is sexually active with one partner. Which of the following additional findings would most strongly suggest a diagnosis of bacterial vaginosis?
A positive amine (whiff) test produces a strong fishy odor when vaginal discharge is mixed with potassium hydroxide (KOH), which is a hallmark finding in bacterial vaginosis (BV). This odor arises from volatile amines produced by anaerobic bacteria such as Gardnerella vaginalis. BV is characterized by a thin, homogeneous gray-white discharge, often without significant itching or irritation, making it a non-inflammatory condition. In contrast, a cottage cheese-like discharge is more often associated with vulvovaginal candidiasis, typically involving intense itching. Vaginal erythema and dyspareunia are more indicative of sexually transmitted infections or inflammatory vaginitis. The presence of motile trichomonads points to trichomoniasis, a sexually transmitted infection unrelated to BV.
BV is the most common cause of vaginal discharge in women of reproductive age and is diagnosed using Amsel’s criteria or Nugent scoring. Focus on the key diagnostic criteria, such as a positive whiff test, clue cells on wet mount, and an elevated vaginal pH (>4.5).