Clue cells are seen in: (REPEAT 2013)

Ans: A (Bacterial vaginosis) Ref: Shaw's Textbook of Gynecology 15 th edition pg.131 Explanation: GARDNERELLA VAGINOSIS Alteration in normal vaginal flora A decrease in number of lactobacilli in vaginal discharge - lactobacilli reduce pH and release hydrogen peroxide toxic to other bacteria 100 fold increase in anaerobic bacteria Hemophilus vaginalis, Gardnerella,, Mobiluncus and Mycoplasma hominis--cause Vaginal discharge without discharge White, milky non-viscous discharge, pH of discharge more than 4.5 Whiff Test - Fishy odour when the vaginal discharge is mixed with 109c KOH - due to the release of amino metabolites from various organisms Presence of Clue Cells - epithelial cells with granular cytoplasm caused by gram-negative bacilli adhering on the surface Wet smear, gram stain and culture are investigations Treatment: Metronidazole 500mg bd for 7 days Ampicillin 500mg or cephalosporin 500mg hd for 7 days Tetracycline 500mg 4 times a day Doxycycline 100mg bd Sulphafurazole Ig 4 times daily for 10-14 days Clindamycin 300mg daily for 7 days Clindamycin 2%cream locally Ornidazole 500mg vaginal tablet for 7 days Lacteal is protein free acidifying lactate gel neutralizes vaginal ph 5ml applied for 7 days AMSEL CRITERIA for diagnosing Bacterial Vaginosis Thin, white, yellow, homogeneous discharge Clue cells on microscopy pH of vaginal fluid >4.5 The release of a fishy odor on adding alkali--10% potassium hydroxide (KOH) solution. At least three of the four criteria should be present for a confirmed diagnosis.