# Trichomoniasis > Trichomoniasis with strawberry cervix, flagellates on wet mount, partner treatment and metronidazole in pregnancy, for NEET-PG Obstetrics and Gynaecology. - Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/trichomoniasis - Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-08 - Last updated: 2026-10-08 - Reference basis: Williams Gynecology; Dutta's Textbook of Gynecology; ICMR Standard Treatment Workflows - How to cite: "Trichomoniasis", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/trichomoniasis ## Direct answer Trichomoniasis is a sexually transmitted infection caused by the flagellate protozoan Trichomonas vaginalis, classically producing a frothy, yellow-green, malodorous discharge with a vaginal pH above 4.5. Motile flagellates on a saline wet mount confirm the diagnosis at the bedside, and nucleic acid amplification testing is the most sensitive option. Metronidazole is the treatment of choice, and both sexual partners must be treated together to prevent reinfection. ## What you must remember - **Causative organism:** Trichomonas vaginalis, a motile anaerobic flagellate protozoan. - **Classic discharge:** Frothy, yellow-green and malodorous, with vulval itching and dyspareunia. - **Strawberry cervix:** Punctate haemorrhagic spots on the ectocervix, called colpitis macularis. - **Wet mount:** Pear-shaped motile flagellates in a saline preparation; the test has only modest sensitivity. - **Most sensitive test:** Nucleic acid amplification testing, with culture as an alternative. - **Treatment:** Metronidazole 500 mg twice daily for seven days is preferred in women, and a single 2 g oral dose is the older alternative. - **Partner management:** Treat sexual partners simultaneously to prevent reinfection, and abstain until both have completed treatment. - **Pregnancy:** Metronidazole is used in pregnancy, while tinidazole is avoided, and untreated infection is linked to adverse outcomes such as preterm birth. ## A stepwise pathway from discharge to cure A 31-year-old woman with frothy green discharge and vulval itching asks for treatment. The steps below take her from bedside findings to treatment of both partners. 1. **Check the speculum findings:** Look for strawberry cervix, a frothy discharge and a vaginal pH above 4.5. 2. **Prepare a saline wet mount:** Pear-shaped motile flagellates with rapid, jerky movement confirm the diagnosis at once. 3. **Confirm by NAAT if needed:** When the wet mount is negative but suspicion stays high, nucleic acid amplification testing is the most sensitive option. 4. **Screen for other STIs:** Test for HIV, syphilis, chlamydia and gonorrhoea, since trichomoniasis often occurs alongside them. 5. **Treat with metronidazole:** Give 500 mg orally twice daily for seven days (the single 2 g dose is the older alternative), and counsel about alcohol avoidance during treatment. 6. **Treat the partner together:** Both partners should be treated at the same time, and sex should be avoided until both have finished therapy and symptoms have resolved. 7. **Retest and follow up:** Retest about three months after treatment, and in pregnancy monitor for preterm birth risk. ## Where the exam tries to catch you Most traps involve treating only one partner, choosing the wrong drug in pregnancy, or dismissing a negative wet mount. - **Trap:** Treating only the woman and not her partner. — **Correct:** Untreated partners cause reinfection, so both must be treated together. - **Trap:** Using tinidazole in a pregnant woman. — **Correct:** Tinidazole is avoided in pregnancy, so metronidazole is the choice. - **Trap:** Ruling out trichomoniasis after one negative wet mount. — **Correct:** Wet mount sensitivity is modest, so NAAT is needed when suspicion remains high. - **Trap:** Calling a frothy green discharge bacterial vaginosis. — **Correct:** Bacterial vaginosis gives a thin grey homogeneous discharge, while trichomoniasis shows flagellates on wet mount. ## Frequently asked questions ### Which organism causes trichomoniasis and how does it look on a wet mount? Trichomonas vaginalis, a flagellated protozoan, causes trichomoniasis. On a saline wet mount it appears as pear-shaped motile organisms with flagella that move in a jerky manner. The sample should be examined promptly, since motility fades on standing. ### What does strawberry cervix indicate in a woman with vaginal discharge? Strawberry cervix describes punctate haemorrhagic spots on the cervix, also called colpitis macularis. It is classically associated with trichomoniasis. It is not diagnostic on its own, but it should prompt testing for Trichomonas vaginalis. ### Can metronidazole be used to treat trichomoniasis in pregnancy? Yes, metronidazole is the recommended treatment for trichomoniasis in pregnancy, and the usual seven-day oral course is used. Tinidazole is avoided in pregnancy. Untreated trichomoniasis is associated with adverse pregnancy outcomes such as preterm birth. ### Why must sexual partners be treated for trichomoniasis at the same time? Trichomoniasis is sexually transmitted, so an untreated partner can reinfect the woman after she completes therapy. Treating both partners simultaneously prevents this cycle of reinfection. Sexual activity should be avoided until both have finished treatment and symptoms have resolved. ### When should a woman be retested after treatment for trichomoniasis? Retesting is recommended about three months after treatment, because reinfection is a recognised risk. Nucleic acid amplification testing is preferred for retesting. Other sexually transmitted infections should also be screened at the same visit.