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
| Feature | Bacterial Vaginosis | Trichomoniasis |
|---|---|---|
| At a glance | Dysbiosis 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 presentation | Reproductive-age woman with thin gray discharge, fishy odor after intercourse, vaginal pH >4.5, clue cells on wet mount, positive whiff test.; Thin, gray-white homogeneous vaginal discharge; Fishy odor, often worse after intercourse or menses; Minimal or no pruritus or inflammation (distinguishes from candidiasis/trichomoniasis); ~50%… | Sexually active woman with frothy malodorous discharge, vulvar pruritus, and strawberry cervix on colposcopy or speculum exam.; Frothy, malodorous yellow-green discharge; Vulvar and vaginal pruritus, burning; Dyspareunia, dysuria; Postcoital bleeding; ~50% of women and most men are asymptomatic; Frothy yellow-green discharge;… |
| Workup / key labs | Amsel 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. Nugent score (gram-stain based) is research/lab gold standard.; Vaginal pH (normal 3.8-4.5; BV >4.5); Wet mount: clue cells (epithelial cells coated with bacteria obscuring… | NAAT (nucleic acid amplification test) — preferred; high sensitivity/specificity; Wet mount microscopy — motile, pear-shaped flagellated trichomonads (~50-70% sensitivity); Point-of-care antigen tests (OSOM Trichomonas, Affirm VPIII) — better than wet mount, suitable for clinical setting; Culture (Diamond medium) — high specificity but… |
| First-line treatment | Metronidazole 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 bedtime × 7 days | 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); Men: metronidazole 2 g PO × 1 dose; Alternative: tinidazole 2 g PO × 1 dose |
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