A 26-year-old woman evaluates at the urgent care center due to four days of copious, malodorous vaginal discharge associated with mild dysuria. Her medical history is unremarkable, and she recently became sexually active with a new male partner. Her temperature is (). Speculum examination demonstrates frothy, yellow-green fluid pooled in the posterior vaginal fornix and several punctate macular hemorrhages on the cervix. A saline microscopy preparation of the fluid reveals multiple motile, pear-shaped, flagellated organisms slightly larger than polymorphonuclear leukocytes. Which of the following is the most appropriate pharmacological intervention?
- Prescribe oral metronidazole for the patient and concurrently treat her sexual partnerAnswer
- BPrescribe oral metronidazole for the patient alone
- CAdminister intramuscular ceftriaxone and oral doxycycline
- DPrescribe a multi-day course of intravaginal terconazole
- EPrescribe intravaginal clindamycin cream for the patient alone
Answer
Prescribe oral metronidazole for the patient and concurrently treat her sexual partner.
The patient's presentation of a malodorous, frothy, yellow-green discharge, punctate cervical hemorrhages (colpitis macularis or 'strawberry cervix'), and motile flagellated organisms on a wet mount is definitively diagnostic of an infection with Trichomonas vaginalis. Because trichomoniasis is a sexually transmitted infection, systemic oral therapy (such as metronidazole) must be prescribed. Furthermore, it is critical to concurrently treat the patient's sexual partner(s) to eradicate the reservoir and prevent 'ping-pong' reinfection.
Step-by-Step Solution
Key Concept
Diagnosis and management of Trichomoniasis, emphasizing the necessity of expedited partner therapy.