Trichomonas

  1. Trichomonas vaginalis
    1. Frequently asymptomatic
    2. Symptoms: frothy discharge, mild pruritis, dysuria, increased symptoms w/menses, "strawberry cervix"
    3. Males: urethritisor asymptomatic
    4. Sexually transmitted; frequently co-existent w/ STDs, especially gonorrhea

Diagnosis:

  1. Wet-mount: motile flagellated protozoa (+ in 40-80%)
  2. Vaginal pH high usually > or = 6.0
  3. Large number of WBCson wet mount
  4. Can culture (+ in 95%) or use enzyme immunoassay or immunofluorescence

Treatment:

  1. Metronidazolex one dose
  2. Not Topical
  3. Concurrent treatment of partner
  4. Evaluation for other STDs
Infxn Sx Vag dc whiff micro pH %ID by direct microscopy
BV foul smell, increased after intercourse thin, homogenous, gray, white + >20% clue cells >4.5 > 90%
Trich frothery, foul smell, pruritis, discharge purulent, profuses, irritating, frothy green yellow +/- incr WBCs, trichomonads > 4.5, often >6 50-70%
Candida pruritis, burning, dc thick, adherent, white neg increased WBCs, budding yeast, pseudohyphae 4 to 4.5 50-60&