Bacterial Vaginosis
Diagnosis and management

Diagnosis requires all of the following criteria

• homogeneous white vaginal discharge
• "clue" cells on wet prep or Gram stain
• vaginal fluid pH ³ 4.5

If candida or trichomonas are present, treat for these conditions and reassess. Treatment is only offered to patients with clinical symptoms or signs, or if intrauterine instrumentation like termination of pregnancy, is anticipated and to some pregnant women.

Standard therapy

metronidazole 400 mg orally 12 hourly for 5 days (ADEC B2)

or

tinidazole 2 g orally as one dose (ADEC B2)

clindamycin cream 2%, 5 g intravaginally at night for 7 days (ADEC A)

or

econazole 150 mg pessaries intravaginally at night for 3 days (ADEC A)

The following points should be discussed:

• The nature of the condition

• It is not proven to be sexually transmitted and partners do not need treatment

• Explain the need to avoid alcohol until 3 days after metronidazole or tinidazole treatment is completed.

• Provide literature on bacterial vaginosis.