Vaginitis History

[select value="1 day|2 days|3 days|4 days|5 days|6 days|1 week|more than 1 week"]  <-- Duration of symptoms
Symptoms include:
[select value="no|yes"] <-- perivaginal itching
[select value="no|yes"] <-- vaginal irritation
[select value="no|yes"] <-- dyspareunia
[select value="no|yes"] <-- white vaginal discharge
[select value="no|yes"] <-- cottage cheese like vaginal discharge
[select value="no|yes"] <-- yellow/green vaginal discharge
[select value="no|yes"] <-- frothy vaginal discharge
[select value="no|yes"] <-- malodorous vaginal discharge
[select value="no|yes"] <-- bloody vaginal discharge
[select value="no|yes"] <-- fever
[select value="no|yes"] <-- pelvic pain
[select value="no|yes"] <-- dysuria
[select value="no|yes"] <-- hematuria
[select value="no|yes"] <-- urinary frequency

[select value="no|yes"] <-- currently pregnant

Relevant history
[select value="no|yes"] <-- diabetes mellitus
[select value="no|yes"] <-- candida vaginitis
[select value="no|yes"] <-- bacterial vaginosis
[select value="no|yes"] <-- Trichomonas vaginitis
[select value="no|yes"] <-- atrophic vaginitis
[select value="no|yes"] <-- STD
[select value="no|yes"] <-- PID
[select value="no|yes"] <-- new sexual partner
[select value="no|yes"] <-- multiple sexual partners