A 34-Year-Old Nulligravid Woman Comes to the Office Due to Vulvar

A 34-year-old nulligravid woman comes to the office due to vulvar itching and vaginal discharge.  She has no other concerns.  The patient is sexually active with her fiancé and takes oral contraceptives daily.  She does not use barrier contraception.  She took antibiotics 2 weeks ago for sinusitis but has no other medical problems.  Pelvic examination shows an erythematous vulva and a thick white discharge that adheres to the vaginal wall.  The rest of the physical examination is normal.  Microscopic examination reveals budding cells.  Which of the following is the most likely underlying cause of her current condition?

A) Decreased glycogen concentration in the vaginal epithelium
B) Decreased number of gram-positive bacteria in the vagina
C) Decreased thickness of the vaginal epithelium
D) Increased alkaline secretions by the cervical mucosa
E) Viral DNA incorporation into lower genital epithelia

Correct Answer:

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