A 30-year-old woman comes to the ambulatory care clinic complaining of vulvar irritation and a profuse, unpleasant-smelling vaginal discharge that began four days ago. She recently became sexually active with a new male partner. Her temperature is 37.0°C (98.6°F), blood pressure is 118/76 mm Hg, and pulse is 78/min. Pelvic examination reveals a frothy, yellow-green discharge pooling in the vaginal vault and small, punctate hemorrhages on the ectocervix. Microscopic evaluation of the vaginal fluid suspended in normal saline demonstrates motile, flagellated organisms that are slightly larger than polymorphonuclear leukocytes. Which of the following is the most appropriate next step in management for this patient?
- APrescribe oral fluconazole for the patient only
- BPrescribe intramuscular ceftriaxone and oral azithromycin for the patient
- Prescribe oral metronidazole for the patient and her sexual partnerAnswer
- DPrescribe oral metronidazole for the patient only
- EPrescribe vaginal clindamycin cream for the patient and her sexual partner
Answer
Prescribe oral metronidazole for the patient and her sexual partner
The correct management is prescribing oral metronidazole for both the patient and her sexual partner. The clinical vignette describes a classic presentation of Trichomonas vaginalis infection, characterized by a profuse, malodorous, frothy, yellow-green discharge and punctate cervical hemorrhages (commonly referred to as a 'strawberry cervix'). The definitive diagnosis is made by visualizing motile, flagellated, pear-shaped organisms on a saline wet mount. Because trichomoniasis is a sexually transmitted infection and the organism can reside in the urethra and Skene's glands, systemic treatment with oral metronidazole (or tinidazole) is required. Crucially, expedited partner therapy or simultaneous treatment of all recent sexual partners is mandatory to prevent recurrent infection.
Step-by-Step Solution
Key Concept
Trichomonas vaginalis presentation and management