USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Trichomonas Vaginitis

The most common patient complaint is vaginal discharge associated with
itching, burning, and pain with intercourse.

Speculum Examination: Vaginal discharge is typically frothy and green. The
vaginal epithelium is frequently edematous and inflamed. The erythematous
cervix may demonstrate the characteristic “strawberry” appearance. Vaginal pH
is elevated >4.5.

Wet Mount: Microscopic examination reveals actively motile “trichomonads”
on a saline preparation. WBCs are seen.

Management: Oral metronidazole for both the patient and her sexual partner.
Vaginal metronidazole gel has a 50% failure rate. Metronidazole is safe during
pregnancy (including first trimester).

Vaginal discharge   >4.5

Itching and burning

“Strawberry”    cervix