What is DOC for Bacterial vaginosis in a pregnant female: and explain in detail?
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 and/or 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 vaginitisM/C 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 pH>4.5<4.5>4.5 (5-6)Gold 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 sabouraud'smedium or NickersonmediumCulture on --Feinberg Whittington media or Diamond mediaT/t = Non pregnant femalesMetronidazole (500 mg BD x 7 days) orClindamycinAzole group of antifungals Like fluconazole/miconazole which can be applied topically or given orally (150 mg, single dose)Metronidazole(2 gm single dose oral)Pregnancy = DOCMetronidazole (250 mg TDS x 7 days)To be avoided in first trimesterTopical azole antifungalsTo be avoided in first trimesterMetronidazole(250 mg TDS x 7 days)Simultaneous 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 prep'Clue cells', bacterial clumps10% KOH solution wet prep Pseudohyphae and bud seenSaline wet prepMotile pear-shaped trichomonadsVulvovaginitis