FIGURE 92.2 A clue cell The vaginal epithelial cell on the right has shaggy borders obscured by coccobacilli (×100 magnification) Management The standard treatment of bacterial vaginosis is oral metronidazole, 500 mg twice daily for days Treatment of patients’ sexual partners does not reduce the recurrence rate and is not recommended Common side effects of metronidazole include GI upset, headache, and a metallic taste Patients should abstain from alcohol during treatment and for 24 hours after treatment with metronidazole to avoid the disulfiram reaction Metronidazole in standard doses is not a human teratogen; however, some clinicians prefer to postpone treatment of pregnant women until the second trimester Intravaginal clindamycin cream (2%, g) and metronidazole gel (0.75%, g) are alternative treatment options for nonpregnant women Oral clindamycin (300 mg twice a day for days) is an alternative treatment regimen for pregnant patients with bacterial vaginosis NONSPECIFIC VAGINITIS Clinical Considerations Clinical Recognition The term nonspecific vaginitis, referring to a disorder of prepubertal girls, encompasses a variety of genitourinary symptoms and signs that are sometimes caused by poor perineal hygiene but that in other cases have no readily