A 25-year-old woman complains of abnormal vaginal discharge. She reports that her copious vaginal discharge has a strong odor, is frothy, and is greenish in color. On physical examination, she is noted to have vaginal erythema with multiple small petechiae. What is the most likely diagnosis?
一位25歲女性主訴陰道分泌物異常。她的分泌物綠色，泡沫狀，而且有異味。陰道檢查：陰道壁充血，多發出血斑點。最有可能的診斷是什麼？
解釋：Trichomonas Vaginitis 滴蟲性陰道炎Symptoms:症狀：
profuse, frothy, greenish, and foulsmelling vaginal discharge
分泌物增多，泡沫狀，綠色，有臭味。
Clinical findings:臨床表現：
1.vaginal and cervical erythema with multiple small petechiae may be seen(strawberry spots)
2.microscopic evaluation of discharge reveals an increase in polymorphonuclear cells and motile flagellates
3.pH of vagina is usually >5.0
4.the labia minora may become edematous and tender
5.urinary symptoms may occur
6.vaginal secretions may also be cultured for T.vaginalis
1.陰道和宮頸充血、多發出血斑點(草莓斑)；
2.電子顯微鏡可見多形核細胞（白細胞）增多和活動的毛滴蟲；
3.陰道內pH值通常大於5.0；
4.小陰唇水腫和疼痛；
5.可能出現泌尿系統症狀；
6.陰道分泌物可以用培養法找陰道毛滴蟲。
Differential diagnosis:鑑別診斷：
bacterial vaginitis or vaginosis, atrophic vaginitis, lichen simplex chronicus, vulvar intraepithelial neoplasia
細菌性陰道炎或陰道病，萎縮性陰道炎，慢性單純性苔蘚，外陰上皮內瘤變
Complications:併發症：
1.associated with a number of perinatal complications
2.associated with an increased incidence in the transmission of HIV
1.與圍產期併發症相關；
2.促使HIV傳播增加。
Treatment:治療：
1.oral metronidazole or tinidazole
2.women with trichomonas should be evaluated for other sexually transmitted infections as well, including gonorrhea, chlamydia, syphilis, and HIV
1.口服甲硝唑或替硝唑；
2.滴蟲感染婦女也應接受其他性傳播疾病的評估，包括淋病、衣原體、梅毒和愛滋病毒。
Prognosis：預後：
recurrence is more likely with treatment noncompliance or failure to treat the partner. concurrent treatment of the partner with avoidance of intercourse is advised until both partners complete treatment
復發主要是患者依從性差或沒有同時治療性伴侶。建議性伴侶雙方同治，治療期間禁止性生活。