Physiologic leukorrhea

The correct answer is C.

Physiologic leukorrhea can be seen during 2 different periods of childhood. Some female neonates develop a physiologic leukorrhea shortly after birth as maternal circulating estrogens stimulate the newborn's endocervical glands and vaginal epithelium. The discharge in these neonates is often gray and gelatinous. Physiologic leukorrhea can also be seen during the months preceding menarche. During this time, rising estrogen levels lead to a whitish discharge not associated with any symptoms of irritation. This patient has a whitish discharge, no other symptoms, and she has had normal pubertal development up to this point. The discharge itself has no characteristics of infection. Therefore, physiologic leukorrhea is the most likely diagnosis.

Bacterial vaginosis (choice A) is not the most likely diagnosis in this patient because the discharge is not malodorous and there are no clue cells seen on microscopic examination of the discharge.

Candida vulvovaginitis (choice B) is not the most likely diagnosis because the discharge is not thick and white (or "cottage-cheese"-like) and the patient has no irritative symptomatology.

Syphilis (choice D) most often presents with a painless ulcer (called a chancre) or is found with serologic testing. A nonmalodorous, whitish vaginal discharge in a 12-year-old female who is not sexually active is almost certainly not evidence of syphilis.

Trichomoniasis (choice E) is also highly unlikely in this patient and the lack of trichomonads on the microscopic examination effectively rules out this diagnosis.

Category: