Trichomoniasis

Pt with h/o unprotected intercourse with multiple sexual partners, smoking, and recreational drug use presents with acute onset yellow-green, frothy vaginal discharge. Reports vaginal pain/soreness since onset of malodorous discharge. Discharge consistent with pt’s description and strawberry cervix noted on exam.

Trichomonas-related discharge on speculum exam

Trichomonas-related discharge on speculum exam

  • Microscopy shows motile, flagellated protozoa

  • Pt is symptomatic and high risk: Obtain trichomoniasis NAAT

  • Obtain gonorrhea/chlamydia NAAT, rapid plasma reagin (RPR), and 4th generation combination HIV-1/2 immunoassay

  • Pregnant and non-pregnant patients: Administer metronidazole 2 g PO x 1 dose

  • Prescribe 1 dose of metronidazole 2 g PO for each of the pt’s recent sexual partners

  • Pt counseled that active trichomoniasis infection places her at higher risk for preterm labor and contracting HIV

  • Pt advised to return in 3 months for a test of cure

Notes

  • 15% of vaginitis cases

  • NAAT = nucleic acid amplification test

  • Presence of trichomoniasis should prompt testing for gonorrhea/chlamydia, syphilis (RPR), and HIV