A 23-year-old woman presents to the clinic with a 4-day history of a copious, malodorous vaginal discharge and mild vulvar itching. She is sexually active with a new male partner and uses oral contraceptive pills consistently. Her temperature is 37.1°C (98.8°F), blood pressure is 110/70 mmHg, and pulse is 76/min. Pelvic examination reveals a frothy, yellow-green discharge in the vaginal vault and punctate macular hemorrhages on the cervix. Vaginal pH is measured at 6.0. Wet mount microscopy demonstrates numerous motile, flagellated organisms slightly larger than polymorphonuclear leukocytes. Which of the following is the most appropriate pharmacotherapy for this patient?
- AIntramuscular ceftriaxone
- BOral azithromycin
- COral fluconazole
- Oral metronidazoleCevap
- EVaginal clindamycin
Cevap
The most appropriate pharmacotherapy is oral metronidazole.
The patient's presentation of a frothy, green-yellow vaginal discharge, 'strawberry cervix' (punctate macular hemorrhages), elevated pH (>4.5), and motile flagellated organisms on wet mount is pathognomonic for Trichomonas vaginalis. The standard first-line treatment for trichomoniasis is systemic therapy with oral metronidazole or tinidazole. Systemic therapy is necessary because the parasite can also infect the Skene and Bartholin glands as well as the urethra. Additionally, all sexual partners must be treated concurrently to prevent reinfection.
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Anahtar Kavram
Diagnosis and management of Trichomonas vaginalis vaginitis.