<prompt> Which one of the following is the best drug of choice for treatment of bacterial vaginosis during pregnancy:ClindamycinMetronidazoleErythromycinRivamycin  <response>: Ans. is b, i.e. MetronidazoleRef. Shaw 14e, p 118; COGDT 10e, p 601; Harrison 17e, p 827Bacterial Vaginosis:It is an alteration in the normal vaginal flora so, termed as vaginosis and not vaginitisPolymicrobial in natureIt is transmitted sexually QInfection is favoured by decrease in the number of protective bacteria of vagina Doderlein bacteria which release hydrogen peroxide and help in maintaining the acidic pH of vagina QSymptoms:-50 are asymptomatic-Rest complain of malodorous vaginal discharge with no irritation. QDiagnosis: By Amsels criteria.Vaginal secretions are grey - white and thinly coat the vaginal walls QpH 4.5?5-5.5 i.e. increased vaginal pH QWhiffs testAmine test is positive, i.e. addition of 10 KOH to vaginal secretions produces Fishy odour QPresence of clue cells 20 of epithelial cells. QCLUE CELLS: are epithelial cells with granular cytoplasm.Microscopic examination shows:Clue cells Q Number of gardnerella vaginalis0 Number of lactobacilli Q Leucocytes conspicuously absent. QTreatment:DOC Metronidazole 500 mg twice daily for 7 days QTreatment of male sexual partner does not improve therapeutic response and is not recommended. QIn pregnancy:-TOC is oral metronidazole after 1st trimester Q-Alternatively, clindamycin can be given-Topical application of metronidazole gel should be avoided during pregnancy. Q 