MCQ – 99267

An infertile woman presents with yellow or green vaginal discharge, Bartholin gland cyst, and proctitis. What is the most probable diagnosis?

Correct Answer » C Explanation

The combination of:

• Yellow-green purulent vaginal discharge
• Bartholin gland involvement (Bartholin cyst/bartholinitis)
• Proctitis
• Infertility (suggesting pelvic inflammatory disease)

is highly suggestive of gonococcal infection caused by Neisseria gonorrhoeae.

The uploaded notes specifically mention:

• Purulent vaginal discharge as the main feature of gonorrhoea.
• Bartholin’s cyst/bartholinitis is commonly caused by gonococcal infection.
• Gonorrhoea is an important cause of pelvic inflammatory disease (PID) and hydrosalpinx, leading to infertility.

Explanation of Each Option

A. Syphilis — Incorrect

• Caused by Treponema pallidum.
• Presents with painless chancre in primary syphilis and generalized rash in secondary syphilis.
• Does not typically cause purulent vaginal discharge, Bartholin gland infection, or proctitis.

B. Trichomoniasis — Incorrect

• Caused by Trichomonas vaginalis.
• Characterized by:
  • Frothy yellow-green vaginal discharge
  • Strawberry cervix
  • Vaginal itching
  • Vaginal pH >4.5
• Does not commonly cause Bartholin gland cyst, proctitis, or infertility.

C. Gonorrhoea — Correct

• Caused by Neisseria gonorrhoeae.
• Clinical features include:
  • Purulent yellow-green vaginal discharge
  • Cervicitis
  • Bartholinitis/Bartholin gland cyst
  • Proctitis (especially with rectal involvement)
  • Pelvic inflammatory disease
  • Tubal infertility due to salpingitis
• The uploaded notes identify gonorrhoea as a cause of Bartholin’s cyst, purulent vaginal discharge, PID, and hydrosalpinx.

D. Candidiasis — Incorrect

• Caused by Candida albicans.
• Produces:
  • Thick, curdy white vaginal discharge
  • Intense vulval itching
  • Dyspareunia
• Does not cause Bartholin gland cyst, proctitis, or infertility.