What is the treatment and management plan for a 26-year-old female with symptoms of a sexually transmitted infection (STI), including painful urination, foul odor, and green-yellow, frothy, malodorous vaginal discharge?

Treatment of Trichomoniasis in a 26-Year-Old Female

The patient has trichomoniasis and should be treated with metronidazole 2g orally in a single dose or tinidazole 2g orally in a single dose as first-line therapy. 1

Diagnosis

The clinical presentation strongly suggests trichomoniasis:

• Painful urination ("peeing razors")
• Foul vaginal odor
• Green-yellow, frothy, malodorous vaginal discharge
• Vulvar and vaginal erythema

These are classic symptoms of Trichomonas vaginalis infection, which is characterized by:

• Yellow-green, frothy vaginal discharge
• Malodor
• Vulvovaginal irritation and inflammation
• Dysuria

Treatment Regimen

First-line Treatment Options:

1. Metronidazole 2g orally in a single dose 2

   • Advantages: Single dose improves compliance
   • FDA-approved for symptomatic and asymptomatic trichomoniasis

2. Tinidazole 2g orally in a single dose 3

   • Alternative option with similar efficacy
   • May have fewer gastrointestinal side effects than metronidazole

Alternative Regimen (if needed):

• Metronidazole 500mg orally twice daily for 7 days
  • Consider for patients with HIV infection 1
  • Consider for treatment failures

Partner Management

• Partner treatment is mandatory to prevent reinfection 1, 2
• The patient's boyfriend should be treated even though he is asymptomatic
• Trichomoniasis is often asymptomatic in males but they can still transmit the infection
• Partners should receive the same treatment regimen as the patient
• Both patient and partner should abstain from sexual intercourse until therapy is completed and both are asymptomatic 1

Follow-up

• Routine follow-up is not necessary if symptoms resolve
• Consider retesting in 3 months due to high rates of reinfection 1, 4
• If symptoms persist, evaluate for:
  1. Reinfection from untreated partner
  2. Medication non-compliance
  3. Possible metronidazole-resistant trichomoniasis 5

Complications and Risk Factors

The patient is at increased risk for:

1. Pelvic Inflammatory Disease (PID) 6, 7

   • Trichomoniasis is associated with upper genital tract infection
   • Can lead to tubal scarring, infertility, and chronic pelvic pain

2. Increased HIV acquisition risk 6

   • Trichomoniasis causes inflammation that increases susceptibility to HIV

3. Adverse pregnancy outcomes if she becomes pregnant 6

   • Including preterm birth and low birth weight

Important Considerations

• Rule out co-infections: Test for chlamydia and gonorrhea, as STIs often occur together 1
• Alcohol warning: Advise patient to avoid alcohol during treatment and for 24 hours after taking metronidazole or 72 hours after tinidazole (can cause disulfiram-like reaction)
• Side effects: Inform about potential nausea, metallic taste, and gastrointestinal discomfort

Prevention Counseling

• Consistent and correct condom use
• Limiting number of sexual partners
• Regular STI screening, especially with new partners
• Importance of partner treatment to prevent reinfection

Trichomoniasis is the most common non-viral STI worldwide, and proper treatment of both the patient and her partner is essential to prevent complications and transmission.