Clinical Signs	Discharge Characteristics	Vaginal pH	Microbiology	Sexually Transmitted?
Bacterial Vaginosis	Vaginal discharge NOT accompanied by leukorrhea, vulvar burning, or pruritis.	Color: off-white Consistency: creamy Consistency: creamy Odor: whiff test positive for fishy or musty odor when alkaline KOH solution added to smear.	>4.5	Polymicrobial; mostly normal flora, but can include comma-shaped, gram-variable anaerobic Mobiluncus rods , Gardnerella vaginalis, or clue cells (> 20 % of the epithelial cells), but few WBCs. Pap smear may indicate coccobacillary shift of flora.	Probably not.
Trichomonads	Irritation and soreness of the vulva, perineum, and thighs, with dyspareunia and dysuria. Punctate cervical microhemorrhages visible in 25% of cases. Asymptomatic up to 50% of the time.	Color: greenish-yellow Consistency: Frothy Odor: foul-smelling	> 4.5 (70% of cases)	Flagellated protozoa visible on wet mount (50%-75%); Pap smear sensitive for trichomonads (70%).	Yes
Candida	Vulvar pruritus, indicating spread of fungus distally onto the vulva. Hyperemic vagina, erythematous or excoriated vulva.	Color: white; off-white if mixed infection present Consistency: "curdled" Odor: not malodorous unless a mixed infection is present	Normal range of 3.8-4.2	Hyphae or budding yeast visible in 50%-70% of cases. Fungal elements on Pap smear could indicate colonization, not infection. Culture can confirm and speciate yeast.	Patients may infect the glans penis of their partners.

• Bacterial Vaginosis
  • Metronidazole 500mg PO bid for 7 days
  • Clindamycin 300mg PO bid for 7 days
  • Metronidazole gel 0.75% bid per vagina for 5 days
  • Clindamycin cream 2% per vagina for 7 nights
• Trichomonas
  • Metronidazole 2g PO, single dose
  • Metronidazole 500mg PO for 7 days
  • Metronidazole 2g or more daily for several consecutive days, supplemented with intravaginal metronidazole suppositories (500mg bid)
  • Metronidazole 500mg IV q8h*
  • Clotrimazole,* single 500mg tablet or cream used once intravaginally at night
• Candida**
  • Intravaginal imidazoles and triazoles (eg, clotrimazole given as single 500mg tablet or cream used once intravaginally at night, miconazole given as 200mg suppository inserted intravaginally once daily at bedtime for 3 consecutive days)
  • Fluconazole 150mg PO for up to 12 consecutive weeks for recurrent infections
  • Boric acid 600mg in #1 gelatin capsule per vagina bid for 10 days

*	Not endorsed by the US Food and Drug Administration for this indication.
**	Cotreatment of the male partner usually not indicated, except in cases of fungal balanitis or in an uncircumcised male with a penile reservoir.