Exam 2 - Trichomoniasis

Question 1

Most common organism causing trichomoniasis

Answer 1

Trichomonas vaginalis

• Five flagella, highly motile

Question 2

How is trichomoniasis transmitted?

Answer 2

Sexual contact

Question 3

Trichomoniasis: signs and symptoms

Answer 3

Strawberry cervix (hemorrhagic petechiae)

• Malodorous
• Copious thin, frothy yellow/green vaginal discharge
• Vulvar vaginal irritation, itching
• Excoriation
• Vaginal or cervical discoloration (deep red/pink color)

Question 4

Trichomoniasis: diagnostic testing

Answer 4

Normally able to diagnosed based on PE and history

• Vaginal discharge pH >4.5
• Positive whiff test
• Motile trichomonads noted on saline wet mount
• Increased WBCs

Question 5

Trichomoniasis: treatment

Answer 5

• Metronidazole 2g PO once OR metronidazole 500mg BID for 7 days
• Tinidazole 2g PO once

Question 6

Trichomoniasis: in pregnancy

Answer 6

• Increases risk of ROM, preterm birth, and low birth weight
• Vertical transmission possible, but rare
  
  • Results in fever, respiratory or genital infection
• Partner can be treated at any time and should be repeated when woman is treated

Question 7

Treatment of choice for trichomoniasis during pregnancy

Answer 7

Metronidazole 2g PO once

• Transmission can still occur
• Treated immediately or wait until 37 weeks if symptoms are not troublesome

Question 8

Trichomoniasis: treatment during breastfeeding - metronidazole

Answer 8

Metronidazole 2g PO once

• Metabolites are transferred in breast milk
• Avoid breastfeeding 12-24 hours after dose

Metronidazole 500mg BID for 7 days

• Tine breastfeeding to coincide with low plasma levels

Question 9

Trichomoniasis: treatment during breastfeeding - tindamax

Answer 9

Tindamax - not recommended in breastfeeding

• Withhold for 72 hours after dose

Question 10

Trichomoniasis: patient education

Answer 10

• Avoid alcohol 24 hours after metronidazole (72 hours after)
• Sexual partners should be treated whether symptomatic or not
• Both partners should abstain from sexual contact until treatment is completed and symptoms resolved
• Can increase risk of HIV acquisition

Question 11

Which medications should the provider consider for resistant trichomoniasis infections with ongoing symptoms?

Answer 11

Tinidazole or longer course of metronidazole