Bacterial vaginosis Diagnosis and management Diagnostic criteria Diagnose BV using either clinical (Amsel) or laboratory (Gram stain with objective scoring system) criteria. B Amsel's diagnostic criteria for bacterial vaginosis Homogeneous vaginal discharge Fishy odor when potassium hydroxide solution is added to vaginal secretions Clue cells on wet mount microscopy Vaginal pH > 4.5 Bacterial vaginosis is likely Antibiotic therapy Offer oral metronidazole 500 mg BID for 7 days in patients with symptomatic BV. Offer vaginal metronidazole gel and oral or vaginal clindamycin cream as alternatives. A Management of recurrent bacterial vaginosis SOGC Q Does the patient have documented multiple recurrences of bacterial vaginosis? Yes Offer longer courses of antibiotic therapy in patients with documented multiple recurrences of BV. A No Continue treatment and follow-up as clinically appropriate.