Cause:Trichomonas vaginalis
Venereal; 10-25% US adult female population carries asymptomatically; present in 30-40% of male partners of infected women
Sx: Profuse, watery vaginal discharge in women, or urethritis in males (rarer, many asx—Ann IM 1993;119:844); dyspareunia
Si:Erythematous cervicitis
PROM and postpartum endometritis
r/o bacterial vaginosis (Nonspecific Vaginitis (Vaginal Bacteriosis, Bacterial Vaginosis)) and candidal vaginitis (Candidiasis (Moniliasis, Local) (Including Vaginal))
Lab:
Bact:Wet prep shows motile, 20-µ flagellate with axostyle undulating membrane, 50-70% sens, 100% specif (Am J Med 2000;108:301); culture possible; rapid DNA and monoclonal antibody tests 90% sens and 99.8% specif (Am J Med 2000;108:301)
Path:Pap smear presence 60% sens, 97% specif (Am J Med 2000;108:301)
Vag discharge pH = 5-6, w amine smell on "whiff test"
Rx:
(CDC—Ann IM 2002;137:255; Med Let 2007;49:73)
Metronidazole 2 gm × 1 po to pt and partner, 90% cure; or 375-500 mg po bid × 7 d, 85-90% cure; local rx no good; ok in pregnancy but does not decr prematurity complc (Nejm 2001;345:487); $9
Tinidazole 2 gm po × 2, 2nd choice
in pregnancy: can use metronidazole; Betadine douche to control sx suppresses fetal thyroid