<prompt> DOC for Bacterial vaginosis in a pregnant female:ClindamycinMetronidazoleErythromycinFluconazole  <response>: Ans. B MetronidazoleMetronidazole, tinidazole and clindamycin are preferred antibiotics for treatment of bacterial vaginosis; however the single best drug of choice is metronidazole.First lineSecond line Metronidazole DOC 500 mg orally BD for 7 days Metronidazole gel 0.75 5 gm intravaginally once a day for 5 days Clindamycin cream 2 5 gm intravaginally once a day for 7 days Tinidazole 2 gm orally OD FOR 2 days Tinidazole 1 gm orally OD for 5 days Clindamycin 300 mg orally BD for 7 days Clindamycin ovules 100 mg OD intravaginally for 3 daysExtra MileInfectious Vulvovaginitis Bacterial vaginosisCandidiasisTrichomonas vaginitisComplaintOrder increased after intercourse andor mensesNote: No inflammation-hence no itchingItching, burning, dischargeFrothy discharge, odor, dysuria, pruritis, spottingMC organismAlteration of vaginal flora; lactobacilli decrease whereas coccobacilli and Gardnerella increaseCandida albicans Candida galbrata Candida tropicalisTrichomonas vaginalisMCOverall: Most common vaginitisMC vaginitis in: Pregnancy, diabetes Immunocompromised OCP users, steroid users, antibiotic users DischargeThin, gray or white adherent, often increasedWhite, curdy Cottage cheese dischargeInflammation Strawberry cervix Yellow-green foul smelling dischargeKOH whiff test--Vaginal pH4.54.54.5 5-6Gold standard investigation Gram stain: on gram staining Nugent scoring is done-The Nugent score is calculated by assessing the presence of lactobacillus Gram ve rods-scored as 0 to 4, Gardnerella vaginalis scored as 0 to 4 and mobilincus Gram variable rods-scored as 0-2 A score of 7 is consistent with bacterial vaginosisCulture on sabouraudsmedium or NickersonmediumCulture on --Feinberg Whittington media or Diamond mediaTt Non pregnant femalesMetronidazole 500 mg BD x 7 days orClindamycinAzole group of antifungals Like fluconazolemiconazole which can be applied topically or given orally 150 mg, single doseMetronidazole2 gm single dose oralPregnancy DOCMetronidazole 250 mg TDS x 7 daysTo be avoided in first trimesterTopical azole antifungalsTo be avoided in first trimesterMetronidazole250 mg TDS x 7 daysSimultaneous treatment of male partnerNot needed as BV is not an STDIf partner has symptoms then treatment neededAlways done as Trichomonas vaginalis is an STDMicroscopic findingsSaline wet prepClue cells, bacterial clumps10 KOH solution wet prep Pseudohyphae and bud seenSaline wet prepMotile pear-shaped trichomonadsVulvovaginitis 