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Microbiology

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Clinical/Applied Microbiology

Question
42 out of 45
 

Nugent’s score is used in the diagnosis of ?



A Bacterial vaginosis
B Trichomonas infection

C.

C Albicans
D LGV

Ans. A Bacterial vaginosis

Diagnostic Features and Management of Vaginal Infection

Feature

Normal Vaginal Examination

Vulvovaginal Candidiasis

Trichomonal Vaginitis

Bacterial Vaginosis

Etiology

Uninfected; lactobacilli predominant

Candida albicans

Trichomonas vaginalis

Associated with Gardnerella vaginalis, various anaerobic and/or noncultured bacteria, and mycoplasmas

Typical symptoms

None

Vulvar itching and/or irritation

Profuse purulent discharge; vulvar itching

Malodorous, slightly increased discharge

Discharge

Amount

Variable; usually scant

Scant

Often profuse

Moderate

Colora

Clear or slightly white

White

White or yellow

White or gray

Consistency

Nonhomogeneous, floccular

Clumped; adherent plaques

Homogeneous

Homogeneous, low viscosity; uniformly coats vaginal walls

Inflammation of vulvar or vaginal epithelium

None

Erythema of vaginal epithelium, introitus; vulvar dermatitis, fissures common

Erythema of vaginal and vulvar epithelium; colpitis macularis

None

pH of vaginal fluidb

Usually 4. 5

Usually 4. 5

Usually 5. 0

Usually >4. 5

Amine ("fishy") odor with 10% KOH

None

None

May be present

Present

Microscopyc

Normal epithelial cells; lactobacilli predominant

Leukocytes, epithelial cells; mycelia or pseudomycelia in up to 80% of C. albicans culture-positive persons with typical symptoms

Leukocytes; motile trichomonads seen in 80–90% of symptomatic patients, less often in the absence of symptoms

Clue cells; few leukocytes; no lactobacilli or only a few outnumbered by profuse mixed flora, nearly always including G. vaginalis plus anaerobic species on Gram's stain (Nugent's score >7)

Other laboratory findings

Isolation of Candida spp.

Isolation of T. vaginalis or positive NAATd

Usual treatment

None

Azole cream, tablet, or suppository—e. g. , miconazole 100-mg vaginal suppository or clotrimazole 100-mg vaginal tablet, once daily for 7 days

Fluconazole, 150 mg orally (single dose)

Metronidazole or tinidazole, 2 g orally (single dose)

Metronidazole, 500 mg PO bid for 7 days

Metronidazole, 500 mg PO bid for 7 days

Clindamycin, 2% cream, one full applicator vaginally each night for 7 days

Usual management of sexual partner

None

None; topical treatment if candidal dermatitis of penis is detected

Examination for STD; treatment with metronidazole, 2 g PO (single dose)

Examination for STD; no treatment if normal

Clinical/Applied Microbiology Flashcard List

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