Grey, frothy vaginal discharge which has a foshy odour, and clue cells are seen on microscopy


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A 23-year-old woman presents to the Sexually Transmined Diseases Clonic complaining of a grey frothy vaginal discharge which has an ammonia or foshy like odour. She admits to unprotected sexual intercourse with two different partners over the past 3 months, and that she has washed up to 2·3 times per day which seems to have no impact on the discharge. General physical examination is unremarkable. You confirm a grey, frothy vaginal discharge which has a foshy odour, and clue cells are seen on microscopy.
Which of the following is the most appropriate treatment?
A Amoxicillin
B Cephalexin
C Ciprofloxacin
D Doxycycline
’ Metronidazole

Explanation
The symptoms and clue cells seen on microscopy are typical of a doagnosis of bacterial vaginosis, it is associated woth an increase in vaginal pH from approximately 4.5 to 5.5, which may actually be further increased in women who use over the counter non pH balanced shower gels. Metronidazole. in the form of local gel and/ or systemic therapy, is the intervention of choice. Whilst Gardnerella is not considered a sexually transmitted disease, goven she has had unprotected intercourse on two occasions in the past 3 months, it is appropriate for her to be offered screening for other STDs.
Amoxicillin, {Option A) is incorrect. Gardnerella is not sensitive to penicillons
Cephalexin, (Option B), is incorrect. Cephalosporins may be used in the treatment of gonorrhoea
Ciprofloxacin, (Option C ), is incorrect. Ciprofloxacin was formerly used as a treatment for gonorrhoea, although resistance patterns mean it is no longer considered a forst line option.
Doxycycline, (Option D), is incorrect. Doxycycline is an intervention for the treatment of gonorrhoea.