You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is Clue cells are seen in: (REPEAT 2013) and explain in detail?
Ans: A (Bacterial vaginosis) Ref: Shaw's Textbook of Gynecology 15 th edition pg.131 Explanation: GARDNERELLA VAGINOSIS Alteration in normal vaginal flora A decrease in number of lactobacilli in vaginal discharge - lactobacilli reduce pH and release hydrogen peroxide toxic to other bacteria 100 fold increase in anaerobic bacteria Hemophilus vaginalis, Gardnerella,, Mobiluncus and Mycoplasma hominis--cause Vaginal discharge without discharge White, milky non-viscous discharge, pH of discharge more than 4.5 Whiff Test - Fishy odour when the vaginal discharge is mixed with 109c KOH - due to the release of amino metabolites from various organisms Presence of Clue Cells - epithelial cells with granular cytoplasm caused by gram-negative bacilli adhering on the surface Wet smear, gram stain and culture are investigations Treatment: Metronidazole 500mg bd for 7 days Ampicillin 500mg or cephalosporin 500mg hd for 7 days Tetracycline 500mg 4 times a day Doxycycline 100mg bd Sulphafurazole Ig 4 times daily for 10-14 days Clindamycin 300mg daily for 7 days Clindamycin 2%cream locally Ornidazole 500mg vaginal tablet for 7 days Lacteal is protein free acidifying lactate gel neutralizes vaginal ph 5ml applied for 7 days AMSEL CRITERIA for diagnosing Bacterial Vaginosis Thin, white, yellow, homogeneous discharge Clue cells on microscopy pH of vaginal fluid >4.5 The release of a fishy odor on adding alkali--10% potassium hydroxide (KOH) solution. At least three of the four criteria should be present for a confirmed diagnosis.