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A 24-year-old woman presents to her primary care physician with a complaint of 1 week of increased vaginal discharge with an unpleasant odor. She is sexually active with one partner and uses oral contraception for birth control. A pregnancy test is negative. Gynecologic examination reveals a pink cervix and a thin white discharge. The discharge has a positive amine “whiff” test and a pH of 6.
Which of the following is the most likely diagnosis?

(A) Bacterial vaginosis
(B) Neisseria gonorrhoeae cervicitis
(C) Trichomonas vaginalis
(D) Vaginal candidiasis
(E) Vulvar candidiasis
 

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Amsel criteria for the Dx of bacterial vaginosis:
Thin, white, yellow, homogeneous discharge
Clue cells on microscopy
pH of vaginal fluid >4.5
Release of a fishy odor on adding alkali—10% potassium hydroxide (KOH) solution
 
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