Which findings are characteristic of bacterial vaginosis?

• A. Fishy odor, increased discharge, elevated pH, clue cells
• B. Positive whiff test
• C. Yeast buds on KOH
• D. Presence of neutrophils in discharge

Answer: (A)

Bacterial vaginosis arises when the normal lactobacilli-dominated vaginal flora is disrupted and replaced by a mix of anaerobic bacteria. The most telling combination of findings is a fishy vaginal odor, a thin grayish or white discharge, a vaginal pH above 4.5, and clue cells seen on microscopy. Clue cells are vaginal epithelial cells coated with bacteria, and they are highly characteristic of BV, anchoring the diagnosis when the other signs are present. The fishy odor is often emphasized after a potassium hydroxide (whiff) test, which is a helpful supportive clue but not required in every case. Yeast infections produce budding yeast or pseudohyphae on KOH and typically cause itching, not the BV pattern. An abundance of neutrophils in the discharge suggests an inflammatory process more typical of other vaginitis etiologies.