Single Best Answer (SBA) · Genital Tract and Sexually Transmitted Infections
A 26-year-old sexually active woman presents with an offensive, frothy, yellow-green vaginal discharge and vulval itching. On speculum examination the cervix has a punctate erythematous ('strawberry') appearance. What is the most likely cause?
Show answer and explanation
Answer: B. Trichomonas vaginalis
Trichomonas vaginalis
An offensive, frothy, yellow-green discharge with vulval itching and a 'strawberry' (punctate erythematous) cervix is classic for Trichomonas vaginalis, a sexually transmitted flagellated protozoan.
Distinguishing the common vaginal discharges
| Cause | Discharge | Clue |
|---|---|---|
| Trichomonas | Frothy, yellow-green, offensive | Strawberry cervix, itch |
| Candida | White, curd-like, non-offensive | Itch, no smell |
| Bacterial vaginosis | Thin, grey | Fishy smell |
| Physiological | Clear/white, non-offensive, non-itchy | Normal |
Treatment
Metronidazole, with partner treatment (it is sexually transmitted). Trichomoniasis is associated with other STIs, so test accordingly.
Why the others are wrong
Candida gives white curd-like non-offensive discharge; BV gives a thin grey fishy discharge; physiological discharge is non-offensive and non-itchy; chlamydia is usually asymptomatic or causes cervicitis without a frothy green discharge/strawberry cervix.
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