Trichomonas vaginalis

Background

Wet mount of trichomonas. Note oval/pear shape with conspicuous flagella.

• Is considered an STI
  • Most cases are asymptomatic (in both men and women).
  • May persist for months to years in infected patients, thus making it difficult to identify whether a patient’s last sexual partner is the source of the infection.
• Associated with preterm birth, PID, cervical cancer, increased transmission of other STIs
  • inflammation of vaginal leads to increased HIV susceptibility

Clinical Features

• Yellow/green, malodorous vaginal discharge
• Vaginal erythema or edema
  • "Strawberry Cervix" on speculum examination.

Differential Diagnosis

Vulvovaginitis

• Bacterial vaginosis
• Candida vaginitis
• Trichomonas vaginalis
• Contact vulvovaginitis
  • Bubble baths and soaps
  • Deodorants, powders, and douches
  • Clothing
• Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
• Lichen sclerosus
• Tinea cruris
• Chlamydia/Gonorrhea infection
• Pinworms
• Vaginal foreign body
  • Toilet paper
  • Other
• Genitourinary syndrome of menopause
• Foreign body
• Allergic reaction
• Normal physiologic discharge

Sexually transmitted diseases

• Chancroid
• Chlamydia trachomatis
• Granuloma inguinale
• Hepatitis B
• Herpes Simplex Virus-2
• HIV
• Human papillomavirus
• Lymphogranuloma venereum
• Neisseria gonorrhoeae
• Trichomonas
• Syphilis

Evaluation

• Wet mount shows mobile trichomonads

Management

Non-Pregnant

• Metronidazole 500mg PO BID for 7 days
• Tinidazole 2g PO once

Pregnant

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

• Metronidazole 500mg PO BID for 7 days

Sexual Partner Treatment

• Female: Same as above
• Male: Metronidazole 2 gm PO x1

Disposition

• Outpatient

See Also

• Vulvovaginitis