Bacterial vaginosis
Background
- Accounts for up to 50% of cases
- Associated w/ preterm labor and premature rupture of membranes
- Treat all symptomatic women (including pregnant)
- Do not treat asymptomatic women (including pregnant)
Diagnosis
- Whitish-discharge and odor
- Lack of discharge makes diagnosis less likely
- Wet mount shows clue cells
Differential Diagnosis
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Atrophic vaginitis
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Vaginal foreign body
Treatment
- Do NOT need to treat sexual partner
- 2 Options: Metronidazole or Clindamycin
Metronidazole
- Metronidazole 2g PO once
<45kg
- 15 mg/kg/day PO divided q8h x 7 days
- First Dose: 7 mg/kg PO x 1
>45kg
- 2 g PO x 1
Pregnancy
- Alternative: 250mg PO q8h x 7 days in pregnant patients[1]
- 2g PO x 1 is also acceptable in pregnancy[1]
- Multiple studies have not demonstrated teratogenicity from metronidazole use[1]
Prophylaxis (Sexual Assault)
- Metronidazole 2 g PO x 1 OR
Weight Based
- <45kg
- 15 mg/kg/day PO divided q12h x 7 days
- First Dose: 7 mg/kg PO x 1
- Max: 1 g/day
- >45kg
- 500mg PO divided q8h x 7 days
- First Dose: 500mg PO x 1
- Max: 2 g/day
Prophylaxis (Sexual Assault)
<45kg'
- 15 mg/kg/day PO divided q8h x 7 days
- First Dose: 7 mg/kg PO x 1
>45kg
- 2 g PO x 1
Clindamycin
- Clindamycin 300mg PO BID x 7 days