Rosh Emergency Medicine Practice Test

What is the most effective treatment for a patient with trichomoniasis presenting with purulent vaginal discharge?

1. Ceftriaxone 500 mg administered intramuscularly once

2. Doxycycline 100 mg administered orally twice daily for 7 days

3. Metronidazole 2,000 mg administered orally once

4. Metronidazole 500 mg administered twice daily for 7 days

The correct answer is: Metronidazole 500 mg administered twice daily for 7 days

The most effective treatment for trichomoniasis, particularly in the presentation of purulent vaginal discharge, is the regimen of metronidazole administered at 500 mg twice daily for 7 days. This is primarily because metronidazole is the first-line antibiotic recognized for treating trichomoniasis, a sexually transmitted infection caused by the protozoan Trichomonas vaginalis. This treatment is effective due to its ability to specifically target this organism, facilitating a complete cure. The prescribed dose and duration (twice daily for a full week) is optimal for ensuring high cure rates and minimizing the chance of recurrence, especially in symptomatic patients. Although a single high dose of metronidazole (2,000 mg) can be effective and is sometimes prescribed, the multi-day regimen provides additional benefits. It can help manage any potential resistance and often addresses co-infections more thoroughly, which may be important in sexually active individuals. Other options, such as ceftriaxone and doxycycline, are not appropriate treatments for trichomoniasis. Ceftriaxone is generally used for gonorrhea and other bacterial infections, while doxycycline is primarily indicated for specific bacterial infections and does not have efficacy against protozoan infections like trichomon