Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, October 01, 2006
    Stalking the Wild Trichomonas

    This may sound strange, but I'll say it anyway: Trichomonas vaginalis is my favorite STD.

    How so, might you ask? (I'll assume I can hear you asking.) For the following reasons: it's easy to diagnose and easy to treat. Further, it doesn't hang around in perpetuity, as do those familiar and nasty viral infections Herpes simplex and HPV.

    Last week, for example, I had a patient who had called several days before asking for a prescription for a "yeast infection." I had prescribed said medication, which had not worked, and the patient then scheduled an appointment for further evaluation. I examined her and my first thought on looking through the speculum was Gee, bright red. My second was Trichomonas. You can often, but not always, make a presumed diagnosis of Trichomonas by looking. The clincher is the "wet mount," or examining the slide under a microscope. The nice thing about this bug is that it is extremely mobile on a slide. Trichomonas is actually a parasite, not a bacteria, and it has lots of flagellae which make it move around quite a bit. Put it in some saline solution under a bright light and you can get quite a show.

    There is a catch. Most of the time it takes about thirty seconds to diagnose once you're looking at the slide... But. There is the occasional case where the patient is extremely symptomatic but for whatever reason you can't find many "trick" on the slide. This lady was such a case.

    So I scanned, and scanned, and scanned again. "I know you're there," I muttered. "I can feel it." (Fortunately no one was in the lab at the time to see me carrying on a conversation with the microscope.)

    At last, there it was: an organism doing the frug in the middle of the magnification field. Aha! Diagnosis made, problem solved... except for the bit about explaining to the patient. I headed back and told the patient what she had and how she got it. She took it stoically, with one comment: "You know I'm going to have to kill him."

    "Just don't make me an accomplice before the fact," I shot back. She laughed. I gave her her prescription - a single dose will take care of this thing - and told her to make sure her partner got treated. Happy ending.




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