<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 42-year-old woman comes to the physician because of vaginal discharge for 3 days. She has no dysuria, dyspareunia, pruritus, or burning. The patient is sexually active with two male partners and uses condoms inconsistently. She often douches between sexual intercourse. Pelvic examination shows thin and off-white vaginal discharge. The pH of the discharge is 5.1. Wet mount exam shows a quarter of her vaginal epithelial cells are covered with small coccobacilli. Which of the following is the most appropriate next step in management?? A: Treat the patient with ceftriaxone and azithromycin, B: Treat the patient and partners with metronidazole, C: Reassurance and follow-up in one week, D: Treat the patient with metronidazole, E: Treat patient and partners with topical ketoconazole,  <response>: This is a patient with vaginal discharge and findings on exam concerning for bacterial vaginosis. Key findings include thin, off-white discharge, pH of 5.1, and clue cells vaginal epithelial cells covered in coccobacilli on wet mount. Bacterial vaginosis is a dysbiosis characterized by a decrease in lactobacilli and an overgrowth of anaerobic bacteria. The most appropriate management is to treat the patient with oral or intravaginal metronidazole. Ceftriaxone and azithromycin would be used to treat gonorrhea or chlamydia. Ketoconazole is an antifungal. Reassurance alone is not adequate given her symptoms and exam findings. The sexual partners do not require treatment.D: Treat the patient with metronidazole 