A 27-year-old woman presented with a malodorous discharge in the vagina which started a week earlier. On examination, Whiff's test is positive and the gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?

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Accepted Answer

Metronidazole. ***Metronidazole***
  - This patient's symptoms (malodorous vaginal discharge, positive **Whiff test**, and presence of **clue cells** on Gram stain) are classic findings for **bacterial vaginosis (BV)**.
  - **Metronidazole** is the first-line and most effective antibiotic for treating bacterial vaginosis, as it targets the anaerobic bacteria overgrowing in the vagina.

*Azithromycin*
  - **Azithromycin** is primarily used to treat infections like **chlamydia**, gonorrhea, or some respiratory tract infections.
  - It is **not effective** against the anaerobic bacteria responsible for bacterial vaginosis.

*Nystatin pessary*
  - **Nystatin** is an **antifungal medication** specifically used to treat **vulvovaginal candidiasis (yeast infection)**.
  - The patient's presentation (malodorous discharge, positive Whiff test, clue cells) does not align with a yeast infection, making nystatin ineffective.

*Tetracycline*
  - **Tetracycline** is a broad-spectrum antibiotic, but it is **not the preferred treatment** for bacterial vaginosis.
  - Its use is often associated with a higher risk of side effects and is typically reserved for other bacterial infections like **chlamydia**, acne, or Rocky Mountain spotted fever. [Practice more OB/GYN questions on OnCourse]

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