Saline wet mount of vaginal secretions—numerous motile trichomonads and no clue cells
KOH wet mount—negative for budding yeast and pseudohyphae
What may one reasonably conclude about Tanya’s diagnosis?
Chlamydia has been ruled out.
Trichomoniasis has been diagnosed and VVC has been ruled out.
The vaginal pH was normal.
What is the appropriate CDC-recommended first-line treatment for this patient?
Metronidazole 2 g orally in a single dose.
Ofloxacin 400 mg orally twice a day for 14 days plus metronidazole 500 mg orally twice a day for 14 days
Hospitalize for intravenous antibiotic administration.
Recommend no pharmacotherapy at this time and refer for follow-up retesting if still symptomatic in two weeks.
Partner Management Tanya has had two sex partners within the past year:
Last sexual contact: two days ago
First sexual contact: two months ago
Frequency, exposure type: Twice a week, vaginal sex
Last sexual contact: six months ago
First sexual contact: seven months ago
Frequency, exposure type: three times a week, vaginal and oral sex
How should Jamie and Calvin be managed?
Since trichomoniasis has no serious sequelae in males, it is not necessary to treat male partners.
Jamie should be treated, and Tanya and Jamie should avoid sex until both are cured (therapy is complete and they are asymptomatic).
They should be treated only if they are symptomatic.
Calvin needs to be treated.
Follow-Up Tanya was prescribed metronidazole 2 g orally, and she was instructed to abstain from sexual intercourse until her current partner was treated.
She returned to clinic two weeks later. She reported taking her medication, but still had persistent vaginal discharge that had not subsided with treatment. She reported abstinence since her clinic visit, and her partner had moved out of the area. Her tests for other STDs (including chlamydia and gonorrhea) were negative.
The vaginal wet mount again revealed motile trichomonads.
What is the appropriate therapy for Tanya now?
Metronidazole 500 mg twice a day for 7 days
Metronidazole gel twice a day for 7 days
Metronidazole or tinidazole 2 g orally once a day for 5 days
Clindamycin 300 mg orally twice a day for 7 days
What are the appropriate prevention and counseling messages for Tanya?
Patients should be instructed to avoid sex until they and their sex partners are treated and cured.
In the absence of a microbiologic test of cure, "cured" is when therapy has been completed and patient and partner(s) are asymptomatic.
Clarify that trichomoniasis is almost always sexually transmitted, and fomite transmission is rare.
Inform the patient that latex condoms can reduce the risk of transmission of trichomoniasis when used consistently and correctly.