A woman with impeccable personal habits has a chronic malodorous discharge. Antibiotics yield transient resolution. She has tried gentian violet applied to her vagina and cervix to no avail. Her surgical history is significant for dilatation and curettage, dilatation of the cervical os, laparoscopy, and hysterosalpingogram. She has no history of sexually transmitted disease. Where do we go from here?
—Gene Duremdes, MD, Princeton, W.Va.
The symptoms exhibited by this patient are classic for bacterial vaginosis. Diagnosis is based on the presence of three of the following: (1) gray milky discharge, (2) discharge pH >4.5, (3) an amine or fishy odor when a drop of KOH is added to the discharge, and (4) clue cells when the discharge is observed under low magnification. Effective therapy includes oral or topical clindamycin or metronidazole or oral tinidazole. Bacterial vaginosis is not a sexually transmitted disorder.
—Daniel Mishell Jr, MD (112-20)