Pediatric emergency medicine trisk 2130 2130
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FIGURE 92.2 A clue cell. The vaginal epithelial cell on the right has shaggy borders obscured
by coccobacilli (×100 magnification).
Management
The standard treatment of bacterial vaginosis is oral metronidazole, 500 mg twice
daily for 7 days. Treatment of patients’ sexual partners does not reduce the
recurrence rate and is not recommended. Common side effects of metronidazole
include GI upset, headache, and a metallic taste. Patients should abstain from
alcohol during treatment and for 24 hours after treatment with metronidazole to
avoid the disulfiram reaction. Metronidazole in standard doses is not a human
teratogen; however, some clinicians prefer to postpone treatment of pregnant
women until the second trimester. Intravaginal clindamycin cream (2%, 5 g) and
metronidazole gel (0.75%, 5 g) are alternative treatment options for nonpregnant
women. Oral clindamycin (300 mg twice a day for 7 days) is an alternative
treatment regimen for pregnant patients with bacterial vaginosis.
NONSPECIFIC VAGINITIS
Clinical Considerations
Clinical Recognition
The term nonspecific vaginitis, referring to a disorder of prepubertal girls,
encompasses a variety of genitourinary symptoms and signs that are sometimes
caused by poor perineal hygiene but that in other cases have no readily
