TABLE 80.2 AMSEL CRITERIA FOR DIAGNOSIS OF BACTERIAL VAGINOSIS Homogeneous discharge that adheres to the vaginal walls pH ≥4.5 Positive “whiff test” (a fishy odor noted before or after the addition of one drop of 10% KOH to a sample of the discharge) Presence of clue cells (comprising at least 20% of the cells) Microscopy from a cervical specimen in patients with cervicitis may reveal greater than 10 white blood cells per high power field NAATs for C trachomatis and N gonorrhoeae from urine, endocervical swab collection, or self-collected vaginal swab will identify infection Keep in mind that a patient who was recently treated for a positive NAAT may continue to have a false-positive test for up to weeks Treatment Physiologic leukorrhea does not require treatment Candidiasis and bacterial vaginosis should be treated with appropriate antimicrobials, and the patient counseled regarding good hygiene including avoidance of harsh soaps, tight-fitting clothes, and douching Suspected sexually transmitted infection should be treated accordingly, even before receiving the results of laboratory tests ( Table 80.3 ) Treatment of a retained foreign body is removal of the foreign body Follow-up of the adolescent patient to assure resolution of symptoms and compliance with treatment course is recommended Patient partners within the preceding months should be referred testing and treatment Pelvic rest is recommended for days after the completion of treatment of the sexually transmitted infection Patients treated for pelvic inflammatory disease should have follow-up at 72 hours as worsening symptoms may indicate need for inpatient admission ( Table 80.4 )