Approach to the Critical Patient

Alarm features and must-not-miss

Red flag conditions requiring urgent evaluation

Key clinical concepts

Diagnostic framework for BV

Pitfalls

Common clinical errors

History

Symptom characterization

Discharge characteristics

Absence of alarm symptoms

Timing and triggers

Episode context

Risk factors

Behavioral and demographic risks

Clinical and device risk factors

Sexual and reproductive history

Partner context

Physical Exam

Vitals and general appearance

Vital sign assessment

Speculum and external exam

External genitalia

Speculum findings

Bimanual and bedside testing

Bimanual examination

Bedside point-of-care tests

Differential Diagnosis

Life threats to exclude first

Pelvic inflammatory disease

Infectious mimics

Vulvovaginal candidiasis

Trichomoniasis

Cervicitis

Non-infectious causes

Desquamative inflammatory vaginitis

Atrophic vaginitis

Irritant or allergic vaginitis

Foreign body

Laboratory Tests

Bedside microscopy

Saline wet mount

KOH preparation

Point-of-care testing

Vaginal pH measurement

Molecular and reference testing

NAAT for vaginitis pathogens

Gram stain with Nugent scoring

Routine bacterial culture

Additional labs when indicated

Pregnancy test

HIV and STI testing

CBC and inflammatory markers

Diagnostic Tests

Scoring Systems

Amsel criteria

Nugent scoring system

Recurrent BV classification

MRI

MRI pelvis indications

CT

CT pelvis or abdomen indications

Ultrasound

Pelvic ultrasound indications

POCUS adjunct

Disposition

Discharge criteria

Outpatient management criteria

Admission indications

Criteria for hospital admission

Referral and follow-up

Specialist referral indications

Follow-up planning

Treatment

First-line antibiotic regimens

Oral metronidazole

Intravaginal metronidazole gel

Intravaginal clindamycin cream

Alternative antibiotic regimens

Secnidazole

Tinidazole regimens

Oral clindamycin

Clindamycin ovules

Recurrent BV management

Acute treatment of recurrent episode

Male partner treatment for recurrent BV

Emerging therapies for recurrent BV

Supportive measures and counseling

Behavioral modifications

Asymptomatic BV

Special Populations

Pregnancy

BV in pregnancy overview

Safe antibiotic regimens in pregnancy

Monitoring and follow-up in pregnancy

Geriatric

Epidemiology in older adults

Management modifications

Pediatrics

Prepubertal children

Adolescents

Background

Epidemiology

Prevalence and burden

Recurrence burden

Pathophysiology

Microbial dysbiosis mechanism

Inflammatory profile

Sexual transmission evidence

Therapeutic Considerations

Antibiotic mechanism and limitations

Recurrence biology and suppression rationale

Evidence base for key decisions

Patient Discharge Instructions

copy discharge instructions

What you have been diagnosed with

Your medication instructions

Things to avoid during treatment

When to return to the emergency department

Follow-up instructions

References

Guidelines and key sources

Primary guidelines

Landmark trials and reviews

Clinical trials

Systematic reviews and meta-analyses

Diagnostic and coding references

Diagnostic codes

Diagnostic performance references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.