The FP noted a strawberry cervix during the pelvic exam and the wet prep revealed the motile protozoan Trichomonas vaginalis, confirming the diagnosis of trichomoniasis.
The majority of men (90%) infected with T. vaginalis are asymptomatic, but many women (50%) report symptoms. The infection is predominantly transmitted via sexual contact. The organism can survive up to 48 hours at 50°F outside of the body, making transmission from shared undergarments or from infected hot tubs possible. Trichomonas infection is associated with low-birth-weight infants, premature rupture of membranes, and preterm delivery, so treatment is especially important in pregnant women.
In this case, the patient was treated with metronidazole 2 g in a single dose and was sent home with the same prescription for her partner, who didn’t come to the office. (According to the Centers for Disease Control and Prevention, sexual partners of patients with Trichomonas infection should be treated.)
Since the patient was at risk for other sexually transmitted diseases, the FP sent off tests for chlamydia and gonorrhea.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Trichomonas vaginitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:504-508.
To learn more about the Color Atlas of Family Medicine, see: http://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
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