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A 22-year-old woman is referred to your public health clinic (thank you PHS for paying off the loans) as a result of contact tracing in a case of gonorrhea. The woman, who had recently had unprotected sexual intercourse with a man symptomatic for gonorrhea, had no symptoms. Physical examination was normal. The pelvic examination is depicted in Figure 1. Cervical culture was obtained for Neisseria gonorrhoeae and Chlamydia trachomatis. Examination of a wet mount of the vaginal discharge revealed the presence of many jerky moving organism depicted in Figure 2.
Figure 1
Figure 2

To obtain the answers to the questions click on the link: answers.

1. What organism is depicted in Figure 2?

2. Is this the most common cause of vaginitis? If your answer is NO then what is the most common cause of vaginitis?

3. How is the organism in Figure 2 most commonly acquired?

4. How would you treat this patient if her Neisseria gonorrhoeae and Chlamydia trachomatis cultures also came back positive?

This contest has been fun to create and I hope you had fun working on it.
Take Care and Think Microbiologically!
Neal R. Chamberlain, Ph.D.

Clue cell

A clue cell is a vaginal epithelial cell that is covered with bacterial cells. Clue cells are seen in patients with another cause of vaginitis than what the woman in this case had called bacterial vaginosis. Note the rough, fuzzy cell membrane of the cell on the right part of the image. Compare it with the really sharp, clear cell membrane if the cell in the upper left part of the image. Clue cells are NOT seen in women with the other two causes of vaginitis; Candida albicans and Trichomonas vaginalis.

Answers 1= Trichomonas vaginalis 2= No. The organisms that cause bacterial vaginosis are the most common cause of vaginal infections. Several organisms are involved however, most people associate Gardnerella vaginalis with this infection. 3= Sexual transmission is the most common means of acquistion. 4= metronidazole for the vaginal infection, doxycycline for the Chlamydia trachomatis infection, and ceftriaxone for the Neisseria gonorrhoeae infection (note: fluoroquinolones, ciprofloxacin, ofloxacin, and levofloxacin, are no longer recommended for treating gonorrhea due to the increasing number of resistant strains being isolated in the US).

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