"vaginosis, bacterial"[MeSH Terms]

CDC STI treatment guidelines bacterial vaginosis recommended regimens

clue cells bacterial vaginosis wet mount

clue cells vaginal epithelial cells coccobacilli Gram stain

~/

mkdir -p /tmp/workspace/bv-ppt/output && cat > /tmp/workspace/bv-ppt/build.py <<'EOF' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE NAVY=RGBColor(0x0B,0x2E,0x4F); TEAL=RGBColor(0x0F,0x8B,0x8D); LIGHT=RGBColor(0xE8,0xF4,0xF4) CORAL=RGBColor(0xE0,0x6C,0x4F); GREY=RGBColor(0x44,0x4F,0x5A); WHITE=RGBColor(255,255,255) FONT="Calibri" prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] def rect(s,x,y,w,h,fill,line=False,shape=MSO_SHAPE.RECTANGLE): r=s.shapes.add_shape(shape,Inches(x),Inches(y),Inches(w),Inches(h)) r.fill.solid(); r.fill.fore_color.rgb=fill if not line: r.line.fill.background() r.shadow.inherit=False return r def text(s,x,y,w,h,t,size=18,bold=False,color=GREY,align=PP_ALIGN.LEFT,anchor=MSO_ANCHOR.TOP): tb=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame tf.word_wrap=True; tf.vertical_anchor=anchor tf.margin_left=tf.margin_right=Inches(0.05); tf.margin_top=tf.margin_bottom=Inches(0.03) p=tf.paragraphs[0]; p.alignment=align r=p.add_run(); r.text=t; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color; r.font.name=FONT return tb def bullets(s,x,y,w,h,items,size=18,color=GREY,space=8): tb=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.word_wrap=True tf.margin_left=tf.margin_right=Inches(0.05) first=True for it in items: p=tf.paragraphs[0] if first else tf.add_paragraph(); first=False p.space_after=Pt(space) if isinstance(it,tuple): b,rest=it r=p.add_run(); r.text="\u2022 "+b; r.font.bold=True; r.font.size=Pt(size); r.font.color.rgb=NAVY; r.font.name=FONT r=p.add_run(); r.text=" "+rest; r.font.size=Pt(size); r.font.color.rgb=color; r.font.name=FONT else: r=p.add_run(); r.text="\u2022 "+it; r.font.size=Pt(size); r.font.color.rgb=color; r.font.name=FONT return tb def header(s,title,sub=None,n=None): rect(s,0,0,13.333,1.15,NAVY); rect(s,0,1.15,13.333,0.06,TEAL) text(s,0.6,0.15,12,0.8,title,32,True,WHITE,anchor=MSO_ANCHOR.MIDDLE) if sub: text(s,0.6,1.3,12,0.45,sub,16,False,TEAL) if n: text(s,12.2,7.05,0.9,0.35,str(n),12,False,GREY,PP_ALIGN.RIGHT) def table(s,x,y,w,colw,rows,size=16,rowh=0.55,hdr=NAVY): nr=len(rows); nc=len(rows[0]) t=s.shapes.add_table(nr,nc,Inches(x),Inches(y),Inches(w),Inches(rowh*nr)).table for i,cw in enumerate(colw): t.columns[i].width=Inches(cw) for r in range(nr): t.rows[r].height=Inches(rowh) for c in range(nc): cell=t.cell(r,c); cell.text="" cell.vertical_anchor=MSO_ANCHOR.MIDDLE cell.margin_left=cell.margin_right=Inches(0.1) p=cell.text_frame.paragraphs[0]; run=p.add_run(); run.text=rows[r][c] run.font.size=Pt(size); run.font.name=FONT cell.fill.solid() if r==0: cell.fill.fore_color.rgb=hdr; run.font.bold=True; run.font.color.rgb=WHITE else: cell.fill.fore_color.rgb=LIGHT if r%2 else WHITE run.font.color.rgb=GREY if c==0: run.font.bold=True; run.font.color.rgb=NAVY return t def notes(s,t): s.notes_slide.notes_text_frame.text=t # 1 Title s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,5.0,13.333,0.08,TEAL) rect(s,0.8,2.0,0.12,2.2,CORAL) text(s,1.1,1.9,11,1.2,"Bacterial Vaginosis",54,True,WHITE) text(s,1.1,3.1,11,1,"Diagnosis and Treatment",34,False,RGBColor(0x9F,0xDD,0xDE)) text(s,1.1,4.2,11,0.5,"Pathogenesis, Amsel criteria, Nugent score, CDC regimens, recurrence, pregnancy",18,False,WHITE) text(s,1.1,5.4,11,0.5,"Sources: Harrison's 22E, Textbook of Family Medicine 9e, Henry's Laboratory Methods, CDC STI Guidelines",14,False,RGBColor(0xBF,0xCF,0xDA)) notes(s,"Overview of BV diagnosis and treatment for clinical teaching.") # 2 Overview s=prs.slides.add_slide(blank); header(s,"What is BV?","A dysbiosis, not a classic infection",2) bullets(s,0.6,1.95,7.2,4.8,[ ("Most common cause","of vaginal discharge and malodor in reproductive-age women"), ("Shift in flora:","lactobacilli-dominated to polymicrobial anaerobes (Gardnerella, Prevotella, Mobiluncus and others)"), ("Vaginal pH rises","as lactic acid-producing lactobacilli are lost"), ("Often silent:","more than half of women with BV are asymptomatic"), ("No inflammation:","hence vaginosis, not vaginitis"), ],19) rect(s,8.2,2.0,4.5,4.4,LIGHT) text(s,8.4,2.1,4.1,0.5,"Normal \u2192 BV",20,True,TEAL,PP_ALIGN.CENTER) rows=[("Dominant flora","Lactobacilli \u2192 Mixed anaerobes"),("Vaginal pH","\u2264 4.5 \u2192 > 4.5"),("Wet mount","Squamous cells \u2192 Clue cells"),("Whiff test","Negative \u2192 Positive")] yy=2.75 for a,b in rows: text(s,8.4,yy,4.1,0.35,a,14,True,NAVY); text(s,8.4,yy+0.33,4.1,0.4,b,16,False,GREY); yy+=0.9 notes(s,"Source: Textbook of Family Medicine 9e; Harrison's 22E.") # 3 Risk factors s=prs.slides.add_slide(blank); header(s,"Risk Factors and Associations",None,3) rect(s,0.6,1.6,5.9,5.2,LIGHT); rect(s,6.85,1.6,5.9,5.2,LIGHT) text(s,0.8,1.7,5.5,0.5,"Risk factors",24,True,TEAL) bullets(s,0.8,2.35,5.5,4.3,["Tobacco use","Intrauterine contraception","New male sexual partner","Sex with another woman","Douching, perfumed soaps, vaginal foreign bodies"],19) text(s,7.05,1.7,5.5,0.5,"Associated complications",24,True,CORAL) bullets(s,7.05,2.35,5.5,4.3,["Postoperative infections","Pelvic inflammatory disease","Preterm delivery and spontaneous abortion","Increased HIV-1 acquisition and transmission","Increased risk of other STIs (recent meta-analysis: HSV-2)"],19) notes(s,"Source: Textbook of Family Medicine 9e; Harrison's 22E; Whitt et al., Viruses 2026 (PMID 41902239).") # 4 Clinical presentation s=prs.slides.add_slide(blank); header(s,"Clinical Presentation",None,4) cards=[("Symptoms",["Thin, gray-white, homogeneous discharge","Fishy or musty odor","Odor worse after intercourse or menses","Little or no itching or burning"]), ("Examination",["Discharge coats the vaginal walls","Vulva and vagina not inflamed","Discharge wipes off easily","Cervix normal"]), ("Pitfalls",["Over half are asymptomatic","Patient self-diagnosis is unreliable","Strong odor predicts BV; no odor makes it unlikely","Itching or erythema suggests another cause"])] x=0.6 for i,(t,items) in enumerate(cards): col=[TEAL,NAVY,CORAL][i] rect(s,x,1.6,3.95,0.7,col); text(s,x,1.6,3.95,0.7,t,22,True,WHITE,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) rect(s,x,2.3,3.95,4.5,LIGHT); bullets(s,x+0.15,2.5,3.65,4.2,items,17) x+=4.2 notes(s,"Source: Textbook of Family Medicine 9e (odor predictive value; self-diagnosis unreliable).") # 5 Amsel s=prs.slides.add_slide(blank); header(s,"Diagnosis 1: Amsel Criteria","Any 3 of 4 criteria confirm BV (use a vaginal, not cervical, sample)",5) table(s,0.6,2.0,12.1,[6.3,2.9,2.9],[ ["Criterion","Sensitivity","Specificity"], ["Vaginal pH > 4.5 (most sensitive)","89%","74%"], ["Clue cells > 20% of epithelial cells on wet mount","74%","86%"], ["Homogeneous gray adherent discharge","79%","54%"], ["Positive whiff test (amine odor with 10% KOH)","67%","93%"]],17,0.7) rect(s,0.6,5.8,12.1,0.9,LIGHT) text(s,0.8,5.8,11.7,0.9,"Clue cells: vaginal epithelial cells heavily coated with coccobacilli, with loss of distinct cell borders (seen at x400).",17,False,NAVY,anchor=MSO_ANCHOR.MIDDLE) notes(s,"Source: Textbook of Family Medicine 9e, Table 25-9, p. 620 (data from Gutman et al., Obstet Gynecol 2005).") # 6 Nugent + other tests s=prs.slides.add_slide(blank); header(s,"Diagnosis 2: Gram Stain and Other Tests",None,6) rect(s,0.6,1.6,6.0,5.2,LIGHT) text(s,0.8,1.7,5.6,0.5,"Gram stain with Nugent score",22,True,TEAL) bullets(s,0.8,2.3,5.6,2.2,["Most specific test when scored in a standardized way","Scores lactobacilli, Gardnerella/Bacteroides and curved rods"],17) table(s,0.8,4.2,5.6,[2.2,3.4],[["Nugent score","Interpretation"],["0 to 3","Normal"],["4 to 6","Intermediate"],["7 to 10","Bacterial vaginosis"]],16,0.5) rect(s,6.9,1.6,5.85,5.2,LIGHT) text(s,7.1,1.7,5.5,0.5,"Other tools",22,True,CORAL) bullets(s,7.1,2.3,5.45,4.4,[ ("Point-of-care tests:","pH, amine and molecular assays when wet mount is unavailable or not diagnostic"), ("Culture:","not recommended. Gardnerella colonizes many healthy women"), ("Pap smear:","not a reliable diagnostic test"), ("Test for STIs","(trichomonas, chlamydia, gonorrhea) when cervicitis or PID is possible")],17) notes(s,"Source: Henry's Clinical Diagnosis and Management by Laboratory Methods (Gram stain with Nugent score most specific; culture not recommended); Symptom to Diagnosis 4e. Nugent score bands are standard (0-3 normal, 4-6 intermediate, 7-10 BV).") # 7 Differential s=prs.slides.add_slide(blank); header(s,"Differential Diagnosis of Vaginal Discharge",None,7) table(s,0.6,1.7,12.1,[2.5,2.4,2.6,2.3,2.3],[ ["","BV","Trichomoniasis","Candidiasis","Normal"], ["Discharge","Thin, gray-white","Frothy, yellow-green","Thick, curdy white","Clear or white"], ["Odor","Fishy","Malodorous","None","None"], ["Symptoms","Odor, discharge","Irritation, dysuria","Itching, burning","None"], ["pH","> 4.5","> 4.5","\u2264 4.5","\u2264 4.5"], ["Microscopy","Clue cells","Motile trichomonads","Pseudohyphae, hyphae","Lactobacilli"]],16,0.75) text(s,0.6,6.4,12.1,0.5,"Mixed infections occur. Test for trichomonas when pH is elevated and BV is not clear-cut.",15,False,TEAL) notes(s,"Source: Harrison's 22E; Textbook of Family Medicine 9e. Composite comparison table.") # 8 Treatment recommended s=prs.slides.add_slide(blank); header(s,"Treatment: Recommended Regimens","CDC STI Treatment Guidelines. Treat symptomatic women",8) regs=[("Metronidazole oral","500 mg twice daily\nfor 7 days"),("Metronidazole gel 0.75%","5 g intravaginally\nonce daily for 5 days"),("Clindamycin cream 2%","5 g intravaginally\nat bedtime for 7 days")] x=0.6 for t,d in regs: rect(s,x,2.0,3.95,2.9,LIGHT); rect(s,x,2.0,3.95,0.1,TEAL) text(s,x+0.1,2.25,3.75,0.8,t,21,True,NAVY,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) text(s,x+0.1,3.2,3.75,1.4,d,20,False,GREY,PP_ALIGN.CENTER) x+=4.2 bullets(s,0.6,5.2,12.1,1.7,[ "Topical and oral therapy have similar cure rates. Topical avoids systemic adverse effects", "Cochrane review: clindamycin and metronidazole have equivalent efficacy; clindamycin cream has fewer adverse events", "Long-term recurrence is common with every regimen"],17,space=6) notes(s,"Source: CDC STI guidelines (bv.htm); Harrison's 22E; Textbook of Family Medicine 9e.") # 9 Alternatives + practical s=prs.slides.add_slide(blank); header(s,"Alternatives and Practical Points",None,9) rect(s,0.6,1.6,6.0,5.2,LIGHT); rect(s,6.9,1.6,5.85,5.2,LIGHT) text(s,0.8,1.7,5.6,0.5,"Alternative regimens",22,True,TEAL) bullets(s,0.8,2.3,5.6,4.4,["Clindamycin 300 mg orally twice daily for 7 days","Clindamycin ovules 100 mg intravaginally at bedtime for 3 days","Secnidazole 2 g oral granules, single dose","Tinidazole 2 g orally once daily for 2 days (cost is higher; Harrison's lists other schedules)"],17) text(s,7.1,1.7,5.5,0.5,"Counseling",22,True,CORAL) bullets(s,7.1,2.3,5.45,4.4,["Avoid douching, which raises relapse risk","Abstain from sex or use condoms during treatment","Clindamycin cream is oil-based and can weaken latex condoms","Nitroimidazoles: alcohol avoidance is often taught; CDC now considers the evidence limited","Treat only if symptomatic (nonpregnant women)","Routine partner treatment for male partners is not recommended"],16,space=6) notes(s,"Source: CDC STI guidelines; Harrison's 22E.") # 10 Recurrence s=prs.slides.add_slide(blank); header(s,"Recurrent BV","Recurrence is common, often within months of therapy",10) steps=[("1","Confirm diagnosis","Amsel or Gram stain. Exclude trichomonas and other causes"), ("2","Retreat","Repeat a 7-day course or switch agent or route"), ("3","Suppress","Metronidazole 0.75% gel twice weekly for several months after a full course"), ("4","Restore flora","Vaginal L. crispatus CTV-05 (LACTIN-V) weekly cut recurrence by about one-third (trial data)")] y=1.95 for n,t,d in steps: c=rect(s,0.6,y,0.8,0.95,TEAL,shape=MSO_SHAPE.OVAL); text(s,0.6,y,0.8,0.95,n,26,True,WHITE,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) text(s,1.6,y,3.0,0.95,t,22,True,NAVY,anchor=MSO_ANCHOR.MIDDLE) text(s,4.7,y,8.0,0.95,d,18,False,GREY,anchor=MSO_ANCHOR.MIDDLE) y+=1.2 notes(s,"Source: Harrison's 22E (suppressive gel; LACTIN-V). Suppression duration per CDC is roughly 3-6 months.") # 11 Pregnancy s=prs.slides.add_slide(blank); header(s,"BV in Pregnancy",None,11) rect(s,0.6,1.6,6.0,5.2,LIGHT); rect(s,6.9,1.6,5.85,5.2,LIGHT) text(s,0.8,1.7,5.6,0.5,"What the evidence shows",22,True,TEAL) bullets(s,0.8,2.3,5.6,4.4,["BV is linked to preterm delivery and spontaneous abortion (meta-analysis of 18 studies)","Treatment trials have not consistently reduced preterm birth, including in women with prior preterm delivery","USPSTF recommends against routine screening of asymptomatic pregnant women"],17) text(s,7.1,1.7,5.5,0.5,"Management",22,True,CORAL) bullets(s,7.1,2.3,5.45,4.4,["Treat symptomatic pregnant women","Oral regimens (metronidazole or clindamycin) are generally preferred","Follow local or CDC dosing for pregnancy","Consider test of cure if high risk for preterm birth"],17) notes(s,"Source: Harrison's 22E; Sethi et al., BMC Pregnancy Childbirth 2025 (PMID 39833700). Pregnancy dosing and test-of-cure advice should be verified against current CDC/ACOG guidance.") # 12 Summary s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY) text(s,0.8,0.5,11,0.9,"Key Takeaways",38,True,WHITE) rect(s,0.8,1.4,1.5,0.07,CORAL) items=[("Diagnose","Amsel 3 of 4, or Gram stain with Nugent 7 to 10. Do not culture."), ("Treat","Metronidazole 500 mg BID x 7 days, metronidazole gel x 5 days, or clindamycin cream x 7 days."), ("Expect relapse","Retreat, then consider suppressive gel."), ("Pregnancy","Treat if symptomatic. Do not screen asymptomatic women routinely.")] y=1.8 for t,d in items: text(s,0.8,y,3.0,1.0,t,24,True,RGBColor(0x9F,0xDD,0xDE),anchor=MSO_ANCHOR.MIDDLE) text(s,3.9,y,8.8,1.0,d,20,False,WHITE,anchor=MSO_ANCHOR.MIDDLE); y+=1.25 text(s,0.8,6.8,11.5,0.4,"Check current CDC and local guidelines before prescribing.",14,False,RGBColor(0xBF,0xCF,0xDA)) # 13 References s=prs.slides.add_slide(blank); header(s,"References",None,13) bullets(s,0.6,1.6,12.1,5.3,[ "Harrison's Principles of Internal Medicine, 22nd ed. Bacterial vaginosis.", "Textbook of Family Medicine, 9th ed. Bacterial vaginosis, Table 25-9 (Amsel criteria).", "Henry's Clinical Diagnosis and Management by Laboratory Methods. Vaginal secretions.", "Symptom to Diagnosis: An Evidence Based Guide, 4th ed. Vaginitis.", "CDC. Sexually Transmitted Infections Treatment Guidelines: Bacterial Vaginosis. cdc.gov/std/treatment-guidelines/bv.htm", "Whitt TN et al. Risk of HSV-2 acquisition among women with BV. Viruses 2026. PMID 41902239.", "Sethi N et al. BV among pregnant women: systematic review. BMC Pregnancy Childbirth 2025. PMID 39833700."],16,space=10) prs.save("/tmp/workspace/bv-ppt/output/BV_Diagnosis_and_Treatment.pptx") EOF cd /tmp/workspace/bv-ppt && python build.py && ls -la output