Trichomonas vaginalis

Trichomonas vaginalis causes vaginitis in women, who may have a stereotypic frothy, green, and foul-smelling discharge. Many women are asymptomatic with trichomoniasis. In addition to causing asymptomatic infection in men, T. vaginalis may cause urethritis. This organism may be suspected in men when patients have repeated treatment failures and no other explanation for symptoms. Microscopic examination of vaginal discharge is 60% to 70% sensitive in women. A first voided urine specimen or urethral swab for microscopic exam may be helpful in identifying the protozoa. Culture for Trichomonas, which requires a special medium, may be necessary to identify this infection accurately in men. Trichomonas is effectively treated with a single 2-g dose of metronidazole (Table 16-11).

For non-STI causes of vaginal discharge, see the online discussion at www.expertconsult.com.

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