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A 27-year-old woman presents with a vaginal itching, odor, and discharge for 1 week. She has one partner who is asymptomatic. Speculum examination shows a strawberry cervix seen with Trichomonas infections (Figure 84-1). This strawberry pattern is caused by inflammation and punctate hemorrhages on the cervix. There is a scant white discharge with a fishy odor. Wet mount shows trichomonads swimming in saline (Figures 84-2 and 84-3). The trichomonads are larger than white blood cells (WBCs) and have visible flagella and movement. She is diagnosed with trichomoniasis and treated with 2 g of metronidazole in a single dose. The patient is tested for other sexually transmitted diseases (STDs) and her partner is treated with the same regimen.

Figure 84-1

Speculum examination showing the strawberry cervix pattern seen with Trichomonas infections. This strawberry pattern is caused by inflammation and punctate hemorrhages on the cervix. There is a scant white discharge. (Courtesy of Richard P. Usatine, MD.)

Figure 84-2

Wet mount showing Trichomonas in saline under low power. There are two visible trichomonads to the right and above the tip of the pointer. The largest cells are vaginal epithelial cells with visible nuclei. (Courtesy of Richard P. Usatine, MD.)

Figure 84-3

Wet mount showing Trichomonas (arrows) in saline under high power. The smaller more granular cells are white blood cells. (Courtesy of Richard P. Usatine, MD.)

Trichomonas vaginitis is a local infection caused by the protozoan Trichomonas vaginalis that is associated with vaginal discharge. The woman often has an itch and an odor along with the discharge but may be asymptomatic.

Trichomoniasis, trich, tricky monkeys.

  • An estimated 3 to 5 million cases of trichomoniasis occur each year in the United States.1
  • The worldwide prevalence of trichomoniasis is estimated to be 180 million cases per year; and these cases account for 10% to 25% of all vaginal infections.2

  • Trichomonas infection is caused by the unicellular protozoan T. vaginalis.3
  • The majority of men (90%) infected with T. vaginalis are asymptomatic, but many women (50%) report symptoms.4
  • The infection is predominantly transmitted via sexual contact. The organism can survive up to 48 hours at 10°C (50°F) outside the body, making transmission from shared undergarments or from infected hot spas possible although extremely unlikely.
  • Trichomonas infection is associated with low-birth-weight infants, premature rupture of membranes, and preterm delivery in pregnant patients.5
  • In a person coinfected with HIV, the pathology induced by T. vaginalis infection can increase HIV shedding. Trichomonas infection may also act to expand the portal of entry for HIV in an HIV-negative person. Studies from Africa have suggested that T. vaginalis infection ...

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