Wednesday, October 7, 2009

Fishy

A 30 year old African American woman presents complaining of vaginal discharge. It is unpleasant but not painful. It is fishy-smelling and occurs after sex. She has multiple sex partners, but denies being at risk for STDs or HIV. She is a smoker. On exam, you note thin off-white homogenous discharge. Vaginal pH is 5. The wet mount is shown below.

Challenge: What do you prescribe?

Image shown under Fair Use.

2 comments:

Alex said...

metronidazole?

Craig Chen said...

:)
-
Fishy

This is bacterial vaginosis due to a change in vaginal flora with decreased lactobacilli and increased anaerobes. This leads to an amine smell and squamous epithelial cell exfoliation. Gardnerella vaginalis may be associated with clue cells (shown here). Treatment is metronidazole (500mg BID x7d or topical gel) or clindamycin.

Sources: UpToDate; aapredbook.aappublications.org.