Ans. is D. i.e. A and C both

• Flagellated parasite; Pruritis; and Sexually transmitted disease  
• Trichomoniasis is caused by a flagellated parasite – Trichomonas vaginalis.
• It is the most commonly encountered vaginal infection and is sexually transmitted. It affects the females of the reproductive age group more commonly.
• Patients complain of profuse frothy thin creamy or greenish colored malodorous discharge with pruritis.

Ans. is D. i.e. a and c both

• Foul-smelling discharge; and Strawberry vagina
• Trichomonas infection causes foul-smelling discharge and strawberry vagina.
• Vaginal pH favoring trichomonas infection is 5-6  or 5.5 to 6.5. So the option ‘b’ is incorrect.
• Trichomonas vaginalis has not been associated with infertility.

Ans. is A. i.e. Trichomoniasis

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar to women usually being symptomatic, while infections in men are usually asymptomatic.

Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Ans. is A. i.e. Greenish discharge

• It is caused by trichomonas vaginal which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar with women usually being symptomatic, while infections in men are usually asymptomatic

Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Ans. is C. i.e. Trichomoniasis

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar to women usually being symptomatic, while infections in men are usually asymptomatic.

 Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Men with trichomoniasis may notice:

• Itching or irritation inside the penis.
• Burning after urination or ejaculation.
• Discharge from the penis.

Ans. is A. i.e. Trichomonas vaginalis

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar with women usually being symptomatic, while infections in men are usually asymptomatic

 Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Ans. is B. i.e. Trichomonas vaginitis

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar & women usually being symptomatic, while infections in men are usually asymptomatic.

Ans. is C. i.e. Assertion is true, but Reason is false

• When vaginal pH raised into 5.5-6.5, trichomonas thrive.
• It is also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.

• This patient is showing features of trichomoniasis caused by Trichomonas vaginalis.
• Patients with this infection usually present with malodorous vaginal discharge, vulvar erythema, itching, dysuria, and dyspareunia.
• On examination, there is a presence of copious frothy yellowish or greenish discharge.
• There is inflammation of the vaginal walls and cervix with punctate hemorrhages.
• Diagnosis is typically made by identifying the organism in vaginal or urethral secretions. The treatment of choice is metronidazole or tinidazole.

Ans. is D. i.e Trichomonas vaginalis
The other organisms listed cause gastrointestinal disease.

• Trichomonas vaginalis is the only organism listed to primarily affect the genital tract rather than the intestinal tract.
• Alfred Francois Donné (1801–1878) was the first to describe a procedure to diagnose trichomoniasis through “the microscopic observation of motile protozoa in vaginal or cervical secretions” in 1836.
• Trichomonas Vaginitis is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body), and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar to women usually being symptomatic, while infections in men are usually asymptomatic.
• The vaginitis it causes is characterized by a frothy, yellow discharge.
• The organism can be identified in Pap smears, or, more reliably, by special culture techniques that are becoming more widely available
• Infection in men is usually asymptomatic, but prostatitis and urethritis can also occur.

Investigations

• IOC– Saline microscopy– Typical motile flagellated trichomonas seen or some kind of motility seen trichomonas may be seen on a pap smear.
• If Pap smear shows trichomonas, do saline microscopy to further confirm the diagnose before initiating treatment.
• Gold standard investigation: Culture on- Feinberg’ Whittington media or Diamond media.
• Amine test/whiff test. i.e. 10% KOH added to discharge-May be positive/or negative due to its association with Bacterial vaginosis.

Diagnosis

• Examination of wet film at 35°C 
• Gram stain or Leishman stain is negative.
• Culture diagnosis
• Cytology
• PCR and NAAT(most sensitive)
• Antigen testing
• Pap smears a greyish blue pear-shaped structure without the flagella.
• A woman diagnosed with Trichomoniasis should also be evaluated for Other venereal diseases.

Treatment with metronidazole is indicated for both the patient and the sexual partner(s).

• The same sexual encounters that spread trichomoniasis can also spread a wide variety of other sexually transmitted diseases, including herpes, human papillomavirus, syphilis, gonorrhea, chlamydia, and AIDS.
• Additionally, the lesions produced by the trichomoniasis particularly facilitate the spread of the AIDS virus, since the normal mucosal barrier is breached.
• The woman’s chance of transmitting AIDS to her partner is also increased by the presence of the trichomoniasis open sores.

Ans. is B. i.e. Trichomonas vaginalis

• Trichomonas vaginalis, the causative organism of trichomoniasis, is a single-celled protozoan parasite with a predilection for infecting the vagina.
• The organism can be identified with intra-office wet mount preparations, cultured, or recognized on Pap smears (although this should be confirmed by culture, as the Pap smear is not a particularly reliable method).
• Candida albicans is a spore- and hyphae -forming fungus that can affect the vagina, often producing a discharge with a white, “cheesy” appearance.
• Entamoeba histolytica is an amoeba that can infect the gut.
• Giardia lamblia is a flagellated parasite that can infect the gut.

Ans. A. Trichomonas vaginitis:
Clinical Features:

• There is sudden profuse and offensive vaginal discharge often dating from the last menstruation.
• Irritation and itching of varying degrees within and around the introitus are common.
• There is the presence of urinary symptoms such as dysuria and frequency of micturition.
• There may be a history of previous similar attacks

On Examination:

• There is thin, greenish-yellow and frothy offensive discharge per vaginum.
• The vulva is inflamed with evidences of pruritus.
• The vaginal examination may be painful. The vaginal walls become red and inflamed with multiple punctate hemorrhagic spots. Similar spots are also found over the mucosa of the portio vaginalis part of the cervix on speculum examination giving the appearance of ‘strawberry’ 

Ans. is B. i.e. Trichomoniasis has no association with immunosuppression.
 

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar to women usually being symptomatic, while infections in men are usually asymptomatic.

 Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Men with trichomoniasis may notice:

• Itching or irritation inside the penis.
• Burning after urination or ejaculation.
• Discharge from the penis.

Ans. is A. i.e. Trichomonas vaginalis

• Hanging drop preparation reveals the presence of motile Trichomonas vaginalis organisms.
• Candida albicans identified by the demonstration of budding yeasts in 10% KOH preparation or Gram smear.
• Gardnerella vaginalis is identified by the demonstration of vaginal epithelial cells with blurred margins due to coating by numerous Gardnerella vaginalis (‘Clue cells’) in vaginal discharge. 
• Mobilincus produce trimethylamine which gives the smell of rotten fish. 

Ans. is D. i.e. All of the above.
Pruritus vulvae is itchiness of the vulva.
Causes: Itch due to infections

• Candida albicans infection (vulvovaginal thrush) is the most important microorganism to consider in a postpubertal woman with vulval itch.
• Bacterial vaginosis causes a frothy, malodorous discharge, and uncommonly causes vulval itch, possibly as a result of contact dermatitis.
• Genital viral warts are often itchy.
• Pinworms can reside in the vagina or anus and cause itch when they exit at night.
• Infections that rarely cause vulval itch include cytolytic vaginosis (associated with vaginal lactobacilli) and trichomoniasis.

Itch due to an inflammatory skin condition
Irritant contact dermatitis is the most common cause of an itchy vulva at all ages. It may be due to diverse causes, including:

• Age-related prepubertal or postmenopausal lack of estrogen
• Underlying tendency to atopic dermatitis
• Scratching for another reason
• Friction from skin folds, clothing, activity, or sexual intercourse
• Moisture due to occlusive underwear
• Urine and/or feces
• Soap or harsh cleanser
• Frequent washing
• Inappropriate or unnecessary chemical applications, including over-the-counter or prescribed medications
• Fissuring of the posterior fourchette
• Normal, excessive or infected vaginal secretions

The severe vulval itch may be due to:

• Lichen simplex
• Lichen sclerosis
• Lichen planus

Other common skin disorders that may cause vulval itch include:

• Psoriasis
• Seborrhoeic dermatitis
• Allergic contact dermatitis*
• Irritant or allergic contact urticaria
• Dermographism
• Folliculitis

Potential vulval allergens include:

• Methylisothiazolinone, a preservative in moist wipes
• Various textile dyes in underwear
• Fragrance in a douche or antiperspirant
• Rubber accelerants in condom, menstrual cup or underwear
• Latex rubber and semen are potential causes of contact urticaria.

Itch due to neoplasia
Benign and malignant neoplastic disorders of the vulva are often asymptomatic in their early stages, but they can cause itch. The most common cancerous lesions are:

• Squamous intraepithelial lesions (SIL, also known as vulval intraepithelial neoplasia or VIN)
• Extramammary Paget disease
• Invasive vulval cancer (squamous cell carcinoma)

Itch due to neuropathy

Ans. is D. i.e. All of the above.

• A strawberry cervix is a finding upon examination where the cervix has a punctate and papilliform appearance.
• It is named because of the superficial appearance of a strawberry.
• As opposed to more general inflammation of the cervix found in cervicitis, the strawberry cervix is considered to be selectively associated with Trichomonas infections.
• Only 2% of women with the infection will have a “strawberry” cervix or vagina on examination. This is due to capillary dilation as a result of the inflammatory response.

Ans.C. Trichomonas vaginalis

Given smear shows infestation of Trichomonas vaginalis.

Investigations for trichomonas vaginitis:

• IOC- Saline microscopy- Typical motile flagellated trichomonas seen or some kind of motility seen trichomonas may be seen on a pap smear.
• Pap smear shows trichomonas, do saline microscopy to further confirm the diagnosis before initiating treatment.
• Gold standard investigation: Culture on- Feinberg’ Whittington media or Diamond media.
• Amine test/whiff test. i.e. 10% KOH added to discharge-May be positive/or negative due to its association with Bacterial vaginosis.

Diagnosis of trichomonas vaginitis-

• Examination of wet film at 35°C. 
• Gram stain or Leishman stain is negative.
• Culture diagnosis.
• Cytology
• PCR and NAAT(most sensitive).
• Antigen testing.
• Pap smears a greyish blue pear-shaped structure without the flagella.   
• A woman diagnosed with Trichomoniasis  should also be evaluated for Other venereal diseases .

Ans. is B, C, D, i.e. T.vaginalis is a flagellated protozoan;  Metronidazole is used for treatment;  Strawberrycervix
Trichomonas vaginitis:

• It is caused by trichomonas vaginalis, a pear-shaped unicellular flagellate protozoa
• On speculum examination, mucosa of the portio vaginalis part of cervix appear like strawberry
• Infection in the genital tract may be responsible for sporadic spontaneous abortion but its relation to recurrent abortion is inconclusive.

Ans is B. i.e. Trichomoniasis

• Patients infected with Trichomonas vaginalis complain of a typical discharge, which is thin, profuse, frothy, irritating, creamy or slightly green.
• The slight green color of the discharge is often not complained by the patient but spotted by the physician.

Ans. is C. i.e Trichomonas vaginalis

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by Trichomonas vaginalis which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body), and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar with women usually being symptomatic, while infections in men are usually asymptomatic.

Ans. is A. i.e. Metronidazole
The drug of choice for Trichomonas vaginitis is Metronidazole.
Treatment

1. Non-pregnant females: Metronidazole (2 gm single-dose oral) or 500 mg BD x 7 days)
2. Treatment of male partner: Always done as Trichomonas vaginalis is an STD.
3. Pregnant females: Metronidazole (250 mg TDS x 7 days), During early pregnancy, vinegar douche to lower the pH, trichofuran suppositories and Betadine gel 
4. If this causes vomiting, or in resistant cases consider the use of alternative drugs tinidazole or secnidazole.

Ans.A. Trichomonas vaginalis
Clinical Features:

• There is sudden profuse and offensive vaginal discharge often dating from the last menstruation.
• Irritation and itching of varying degrees within and around the introitus are common.
• There is the presence of urinary symptoms such as dysuria and frequency of micturition.
• There may be a history of previous similar attacks.

On Examination:

• There is thin, greenish-yellow and frothy offensive discharge per vagina.
• The vulva is inflamed with evidences of pruritus.
• The vaginal examination may be painful.
• The vaginal walls become red and inflamed with multiple punctate hemorrhagic spots.
• Similar spots are also found over the mucosa of the portio vaginalis part of the cervix on speculum examination giving the appearance of ‘strawberry’.