Pediatric emergency medicine trisk 2125 2125
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trichomoniasis but is visible without colposcopy in only about 2% of infected
patients.
Clinical Assessment
For patients of all ages, Trichomonas vaginalis is best detected by antigen testing
using vaginal swabs collected and evaluated by immunoassay or nucleic acid
amplification test with a sensitivity of greater than 95%. Historically, the
diagnosis was made if characteristically motile, flagellated trichomonads are seen
in a saline suspension of discharge examined microscopically within about 15
minutes after the specimen has been obtained ( Fig. 92.1 ). However, the
sensitivity rate for wet mount examinations is only 50%. Cultures from a
specialized parasite medium have a sensitivity of 85% to 95%, but results are
delayed, generally taking several days.
Management
Metronidazole is effective for the treatment of vaginal trichomoniasis. The
dosage for infants is 15 mg/kg/day orally in two to three divided doses for 7 days.
Recommended treatment of adolescents includes metronidazole 2 g orally in a
single dose, 500 mg orally twice daily for 7 days, or tinidazole 2 g orally in a
single dose. Because trichomoniasis is a sexually transmitted disease, the patient’s
partner(s) must also be treated (expedited partner therapy) or referred for
treatment.
Nausea and an unpleasant taste are common side effects of nitroimidazoles.
Alcohol should be avoided during treatment and 24 to 72 hours after treatment to
prevent the occurrence of more severe abdominal pain, vomiting, flushing, and
headache (disulfiram reaction). Patients should continue to abstain from alcohol
for 24 hours after completion of metronidazole and 72 hours after completion of
tinidazole. Recent data indicate that metronidazole is not a teratogen, but many
clinicians prefer to postpone treatment of pregnant patients until the second
trimester. Intravaginal clotrimazole (two intravaginal tablets at bedtime for 7
days) can provide symptomatic relief for pregnant patients but will cure only 10%
to 20%.
SHIGELLA VAGINITIS
Clinical Considerations
Clinical Recognition
