Case #512 – March, 2020

A 29-year-old female patient presented to her primary care physician reporting a 15-day history of whitish, vaginal discharge associated with itching. She also complained of lower abdominal pain. A vaginal, speculum examination revealed an inflamed cervix with red, punctate lesions. A Pap smear collected at the time of examination was sent to the pathology lab for a Papanicolaou stain. Figures A and B show what the pathologist observed using an oil immersion objective. The objects of interest measured 10-15 µm long. What is your diagnosis? Based on what criteria?

Case and images courtesy of Dr. Prasad, Professor of Pathology, Sri Devaraj Urs Medical College, Kolar-563101, Karnataka, India

Figure A

Figure B

This is a case of trichomoniasis caused by the protozoan Trichomonas vaginalis. Diagnostic features included:

Pear-shaped organism (trophozoite) with several flagella projecting anteriorly and a single flagellum observed at the opposite end.
A large nucleus with an eccentric karyosome (Figure A).
Organism approximately 10 x 7µm within the size range for Trichomonas vaginalis.