Trichomonas vaginitis is a sexually transmitted infection produced by the protozoan Trichomonas vaginalis. The organism is found not only in the vagina but also in the urethra and in Skene's glands and paraurethral ducts.
The primary symptom of Trichomonas vaginitis is severe pruritus, irritation, and, often, vulvar dysuria, accompanied by a grossly and microscopically purulent vaginal discharge. Sometimes, pelvic pain is present. The severity of disease varies widely, with some patients exhibiting fairly mild symptoms and signs. The infected male partner is usually asymptomatic. A physical examination reveals deep redness of the introitus, vagina, and cervix, classically but nonspecifically and unpredictably producing a "strawberry cervix.'' This finding is characterized by a red cervix covered with monomorphous, discrete, bright-red, tiny papules. Vaginal secretions are most often described as yellow and frothy. Microscopically, vaginal secretions show small (about the size of white blood cells), rapidly moving, teardrop-shaped, flagellate organisms that quickly lose motility and distinctive shape as they cool. In addition, very large numbers of neutrophils are present and lactobacilli are absent, resulting in a high vaginal pH.
The differential diagnosis includes all causes of purulent, inflammatory vagin-itis. Desquamative inflammatory vaginitis, atrophic vaginitis, and the occasional bacterial vaginitis (not vaginosis) produce vestibular and vaginal/cervical erythema and vaginal secretions with similar microscopic findings. However, the causative organism is absent. The diagnosis is made by the setting and the identification of the organism microscopically.
Treatment consists of oral metronidazole 500 mg twice a day for one week or 2 g orally in one dose. Topical medications are not sufficient because of the organisms protected within the urethra and paraurethral ducts. Sexual partners should be treated as well. Trichomonas resistant to metronidazole occurs occasionally, and those patients can be treated with tinidazole (Table 18) (60,61).
Was this article helpful?