Gynaecology & Obstetrics

A 24-year-old patient presents to your office with complaints of a 1 -week history of vulvar itching and vaginal discharge. She endorses that she has had intercourse with two individuals in the past 6 months without the use of a condom. On physical examination, the vulva is edematous. Yellow-green discharge is present on the vaginal walls and at the cervical os. The cervix is strawberry red Wet smear of vaginal secretions shows epithelial cells, white blood cells (WB Cs), and flagellate protozoa. You prescribe an antibiotic. What warning do you give about this particular treatment?

Avoid sun overexposure

Avoid taking on an empty stomach

Avoid taking with grapefruit juice

Avoid alcohol

Ans. (d) Avoid alcohol. Metronidazole. T. vaginalis is a flagellate protozoan that is transmitted by sexual contact and causes a yellow-green frothy discharge. In 10 % of the population, T. vaginalis can cause petechiae or "strawberry patches" on the upper vagina and cervix. Diagnosis is made by wet smear of vaginal discharge. Treatment of trichomoniasis is oral metronidazole major side effect is antabuse effect-alcohol may cause an up set stomach, vomiting, stomach cramps, headaches, sweating, and flushing (redness of the face). Visual clue: After application of 5% acetic acid. This condition is associated with what is know as - Strawberry vagina. Trichomonas vaginalis infection is detected by frothy greenish or yellowish foul-smelling discharge">

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