USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Bacterial   Vaginosis

Bacterial vaginosis is not sexually transmitted, but rather is associated with
sexual activity. The most common patient complaint is a fishy odor. Itching and
burning are not present.

Speculum examination: The vaginal discharge is typically thin, grayish-white.
No vaginal inflammation is noted. Vaginal pH is elevated >4.5. A positive
“whiff” test is elicited when KOH is placed on the discharge, releasing a fishy
odor.

Wet mount: Microscopic examination reveals “clue cells” on a saline
preparation. These are normal vaginal epithelial cells with the normally sharp
cell borders obscured by increased numbers of anaerobic bacteria. WBCs are
rarely seen.

Management. Oral or vaginal metronidazole or clindamycin; metronidazole is
safe during pregnancy (including first trimester).

Vaginal discharge   pH  >4.5

Fishy   odor

“Clue”  cells