Trichomonas vaginalis

Question 1

The most common STI worldwide is Trichomonas Vaginalis, which is a Flagellate Protozoon parasite with >167 million new cases/year. Does this occur in men and/or women?

Answer 1

• almost always women
• women 14:1 men
• Accounts for 1% of GUM clinic attendances in the UK

Question 2

Which age group are most likely to contract Trichomonas Vaginalis?

1 - 15-20
2 - 20-30
3 - 30-40
4 - >50

Answer 2

3 - 30-40

Question 3

Do all patients who have Trichomonas Vaginalis (TV) present with symptoms?

Answer 3

• no
• 10-50% are asymptomatic

Question 4

Trichomonas Vaginalis (TV) can present in a variety of ways. Which of the following is NOT a typical symptom of TV?

1 - vaginal discharge that is purulent, yellow/green and/or frothy
2 - vulvovaginitis
3 - intrauterine bleeding
4 - external dysuria

Answer 4

3 - intrauterine bleeding

Question 5

Trichomonas Vaginalis (TV) can present in a variety of ways. Which of the following is NOT a clinical sign of TV?

1 - vaginal discharge that is purulent, yellow/green and/or frothy
2 - strawberry cervix
3 - pH > 4.5
4 - polyps around cervix

Answer 5

4 - polyps around cervix

Question 6

What is currently the best approach to diagnose patients with Trichomonas Vaginalis (TV)?

1 - hysteroscopy with biopsy
2 - colposcopy
3 - microscopy of a wet mount
4 - PCR

Answer 6

3 - microscopy of a wet mount
- has a sensitivity of 40-80%

• Cervical cytology has a 30% false positive rate
• PCR is becoming more common

Question 7

What is the 1st line medication when treating a patient with a confirmed diagnosis of Trichomonas Vaginalis?

1 - cephalexin 1g BD for 3 days
2 - ceftriaxone 1g TDS for 5 days
3 - doxycycline 100mg 400mg TDS for 3 days
4 - metronidazole 400mg BD PO for 7 days

Answer 7

4 - metronidazole 400mg BD PO for 7 days
- also given a single dose of metronidazole at 2g, BUT not in pregnancy

• topical treatment is ineffective – infects urethra and para-urethral glands