Review Question - QID 106223

This patient is suffering from trichomonas vaginitis, as evidenced by the foul smelling yellow-green discharge. Appropriate treatment is metronidazole for the patient and her partner.

Trichomonas vaginitis, caused by the flagellated parasite Trichomonas vaginalis, is the most common cause of vaginitis worldwide but the least most common cause in the United States. The disease is sexually transmitted. Males may harbor asymptomatic infection and should be treated with metronidazole to prevent spread of the disease.

Hainer and Gibson review vaginitis. Trichomoniasis symptoms are not specific, and diagnosis is often made by microscopy. The presence of trichomonads with saline, leukocytes more numerous than epithelial cells, a positive whiff test, and vaginal pH greater than 5.4 is suggestive of trichomonas vaginitis.

Lazenby et al. studied the correlation between trichomonas vaginitis and leukorrhea. They found leukorrhea to be associated with a 4-fold-increased risk of infection. Leukocytes on microscopy was also associated with Trichomonas vaginitis. They recommend that patients with leukorrhea be evaluated with more-sensitive tests for trichomonas if microscopy is negative.

Figure A shows cervical cells infected with Trichomonas vaginalis, a motile flagellated parasite.

Incorrect answers:
Answers 1 and 2: Clindamycin is an appropriate treatment for bacterial vaginosis, which is a grayish watery discharge.
Answer 3: Metronidazole is an appropriate treatment for trichomonas vaginitis. The patient and her partner should be treated when trichomonas vaginitis is diagnosed.
Answer 5: Oral fluconazole is an appropriate treatment for candida vaginitis, which is more of a cottage cheese discharge.