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Updated: Mar 14 2019


  • Snapshot
    • A 23-year-old woman presents to her gynecologist for a wellness exam. She reports that she has been having a “fishy” vaginal odor for the past 3 days. She endorses to recently being sexually active with a new partner and does not use barrier contraception. Physical examination is notable for gray vaginal discharge that has a fishy odor. Nucleic acid amplification testing for gonorrhea and chlamydia is negative. An amine whiff test enhances the fishy odor. Vaginal fluid pH is > 4.5. There are clue cells with a stippled appearance on the outer margins on microscopic testing of the vaginal fluid. She is started on metronidazole. (Bacterial vaginosis)
  • Introduction
    • Mechanism of action
      • free radical formation that damages bacterial DNA
        • is bactericidal and has antiprotozoal activity
    • Clinical use
      • protozoal infections
        • Giardia
        • Entamoeba
        • Trichomonas
      • anaerobic bacteria (below the diaphragm)
        • Bacteroides
        • Clostridium difficile
        • Gardnerella vaginalis
      • Helicobacter pylori
        • as part of triple therapy in patients who are penicillin allergic
    • Adverse reaction
      • disulfiram-like reaction
        • when consuming alcohol, patients can experience severe flushing, hypotension, and tachycardia
      • metallic taste
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