Which one of the following is the best drug of choice for treatment of bacterial vaginosis during pregnancy:

Ans. is b, i.e. MetronidazoleRef. Shaw 14/e, p 118; COGDT 10/e, p 601; Harrison 17/e, p 827Bacterial Vaginosis:It is an alteration in the normal vaginal flora (so, termed as vaginosis and not vaginitis)Polymicrobial in natureIt is transmitted sexually QInfection is favoured by decrease in the number of protective bacteria of vagina ("Doderlein bacteria" which release hydrogen peroxide and help in maintaining the acidic pH of vagina Q)Symptoms:-50% are asymptomatic-Rest complain of malodorous vaginal discharge with no irritation. QDiagnosis: By Amsel's criteria.Vaginal secretions are grey - white and thinly coat the vaginal walls QpH >4.5([?]5-5.5) (i.e. increased vaginal pH) QWhiffs test/Amine test is positive, i.e. addition of 10% KOH to vaginal secretions produces Fishy odour QPresence of 'clue cells' (>20% of epithelial cells). QCLUE CELLS: are epithelial cells with granular cytoplasm.Microscopic examination shows:Clue cells Q| Number of gardnerella vaginalis0| Number of lactobacilli Q| Leucocytes (conspicuously absent). QTreatment:DOC Metronidazole 500 mg twice daily for 7 days QTreatment of male sexual partner does not improve therapeutic response and is not recommended. QIn pregnancy:-TOC is oral metronidazole after 1st trimester Q-Alternatively, clindamycin can be given-Topical application of metronidazole gel should be avoided during pregnancy. Q