Confusable diagnoses · PANCE / PANRE

Bacterial Vaginosis vs Trichomoniasis

Bacterial Vaginosis and Trichomoniasis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Bacterial Vaginosis vs Trichomoniasis at a glance

  • Bacterial Vaginosis: Dysbiosis of vaginal flora — loss of lactobacilli with overgrowth of anaerobes; thin gray discharge with fishy odor.
  • Trichomoniasis: Sexually transmitted protozoal infection — frothy yellow-green discharge, strawberry cervix; treat patient and partners.
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Side-by-side comparison

FeatureBacterial VaginosisTrichomoniasis
At a glanceDysbiosis of vaginal flora — loss of lactobacilli with overgrowth of anaerobes; thin gray discharge with fishy odor.Sexually transmitted protozoal infection — frothy yellow-green discharge, strawberry cervix; treat patient and partners.
Classic presentationReproductive-age woman with thin gray discharge, fishy odor after intercourse, vaginal pH >4.5, clue cells on wet mount, positive whiff test.; Thin,…Sexually active woman with frothy malodorous discharge, vulvar pruritus, and strawberry cervix on colposcopy or speculum exam.; Frothy, malodorous…
Workup / key labsAmsel criteria (3 of 4): (1) thin homogeneous gray-white discharge, (2) vaginal pH >4.5, (3) positive whiff test with KOH, (4) clue cells on saline wet mount.…NAAT (nucleic acid amplification test) — preferred; high sensitivity/specificity; Wet mount microscopy — motile, pear-shaped flagellated trichomonads (~50-70%…
First-line treatmentMetronidazole 500 mg PO BID × 7 days; Metronidazole 0.75% vaginal gel 5 g intravaginally daily × 5 days; Clindamycin 2% vaginal cream 5 g intravaginally at…Women: metronidazole 500 mg PO BID × 7 days (CDC 2021 — replaced single 2 g dose for women based on trial data showing lower recurrence with 7-day regimen);…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.