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A 24-year-old woman comes to the clinic complaining of a vaginal discharge for the last 3 days. She describes the discharge as copious, watery, and bubbly. She also complains of symptoms of dysuria lasting for the past 5 days. When asked about her sexual history, she reports that although she normally practices safe sex, she occasionally gets "caught up in the moment." She thinks she has had "about ten" partners during the last year, but is currently "steady" with one sexual partner. She has never previously been tested for HIV, or for any other sexually transmitted disease. She is extremely agitated and concerned that she may have an infection, and wants to be tested for any sexually transmitted diseases. Other than her current symptoms, she has been in good health. Review of systems and past medical history are unremarkable. Her temperature is 37 C (98.6 F). Abdominal examination reveals some mild suprapubic tenderness. Pelvic examination demonstrates a white discharge that pools in the vaginal vault, vaginal wall erythema, and multiple small punctate hemorrhages on the cervix. Cervical cultures are obtained for Chlamydia trachomatis and Neisseria gonorrhea. Examination of a wet prep reveals a protozoan organism with characteristic jerky motility. The patient is given a prescription for metronidazole, and an HIV screening test and RPR are drawn. A return visit is scheduled for next week. Which of the following is an additional appropriate course of action?
A. Do polymerase chain reaction testing for Trichomonas vaginalis
B. Give empiric penicillin G
C. Give an intramuscular injection of ceftriaxone
D. Have the patient bring her partner in for treatment
E. Report this disease to public health authorities
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STD diseases can be reported to public health authorities syphillis,chalamydia,gonorrea,PID etc except trichomonas. so not E for sure,B and C(have not yet received results to give them)
About A,Vaginal trichomoniasis is typically diagnosed with microscopy. A vaginal swab sample for saline wet mount evaluation is an easy, valuable, and economical tool, but specificity is limited and the slide should be evaluated immediately.Trichomonads, which are ovoid-shaped parasites, are slightly larger than polymorphonuclear lymphocytes (PMNs) and may be identified by their ameboid mobility. Trichomonads cause an inflammatory reaction; therefore, a large number of PMNs are usually present and correlate with the severity of the infection.
Microscopy yields a sensitivity of 60-70% in the detection of T vaginalis in vaginal secretions.The absence of trichomonads on microscopy does not exclude the possibility of trichomoniasis.
Culture is more sensitive and specific than microscopy.Culture is especially important for diagnosing trichomoniasis in men since the wet preparation findings are usually negative. Urethral swab, urine, and semen cultures are used to maximize sensitivity
Trichomonads may be viewed on Papanicolaou (Pap) smear, but this test yields low sensitivity and should not be relied on for diagnosis (50%). False-positive results are also common with this technique.
Polymerase chain reaction (PCR) methods yield a high sensitivity (84%) and specificity (94%). Although not yet widely available, PCR has great diagnostic potential.
Positive wet prep is more than enough to think about TV and hence started treatment with Metronidazole..so only left ans is D.
