0071643192.pdf

OBSTETRICS AND GYNECOLOGY

602

Trichomoniasis is almost

always an STD!

DIAGNOSIS

■ Usually, visualization of the vagina allows a clinical diagnosis.

■ Confirm diagnosis based on the presence of pseudohyphae and spores

(“spaghetti and meatballs”) on wet mount exam with a 10% KOH prep.

TREATMENT

Oral or intavaginal antifungals:

■ Clotrimazole 1% cream or miconazole 2% cream topically for 3–7 days

■ Fluconazole 150 mg PO ×one dose

A 50-year-old female presents to the ED with the third visit in 2 months

for candida vulvovaginitis that seems resistant to treatment. What do you

want to check?

Accucheck to rule out underlying diabetes.

TRICHOMONIASIS

Caused by Trichonomas vaginalis, a flagellated protozoan.

SYMPTOMS/EXAM

■ Vaginal discharge, perineal itching, dysuria, spotting, and pelvic pain

■ Physical exam shows vaginal erythema and a frothy malodorous discharge.

■ Trichomoniasis is associated with premature rupture of membranes,

preterm delivery, and postpartum endometritis.

DIFFERENTIAL

Bacterial vaginosis, candida vaginitis, pelvic inflammatory disease

DIAGNOSIS

The presence of motile, pear-shaped, flagellated trichomonads on wet mount

(see Figure 12.5).

TABLE 12.5. Vaginal Discharge

BACTERIAL

DISCHARGE NORMAL CANDIDIASIS TRICHOMONIASIS VAGINOSIS

Color Clear/white White Green/yellow Gray/white

pH <4.5 <4.5 >5.0 >4.5

Amine odor Negative Negative Positive Positive

with KOH

Wet mount Epithelial cells, WBC, spores, WBC, motile Few WBC,

lactobacilli pseudohyphae trichomonads clue cells