A woman presents with frothy green vaginal discharge, intense pruritus, and a negative Whiff test. What is seen on microscopy?

Appeared in: INI-CET EXAM -2026

Explanation

The patient's presentation with frothy, yellow-green vaginal discharge and intense itching (pruritus) are the hallmark symptoms of trichomoniasis.
Trichomoniasis is a sexually transmitted infection (STI) caused by the protozoan Trichomonas vaginalis.
The definitive diagnosis is confirmed by a wet mount microscopic examination of the vaginal fluid, which reveals the characteristic pear-shaped, motile organisms with flagella.

Option B: Clue cells are vaginal epithelial cells coated with bacteria, which is the hallmark microscopic finding for Bacterial Vaginosis (BV), not trichomoniasis.
Option C: Yeasts with pseudohyphae are characteristic of vulvovaginal candidiasis (a yeast infection), which typically presents with a different type of discharge.
Option D: Candida is the name of the causative fungus for a yeast infection, not the description of the microscopic finding itself. The finding would be 'yeasts with pseudohyphae'.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of vaginitis based on clinical presentation and microscopic findings as background academic context rather than a clinical decision trigger.
Accurate diagnosis of vaginitis is crucial as treatment is specific: metronidazole for trichomoniasis, but antifungals for candidiasis. Misdiagnosis leads to treatment failure and persistent symptoms.
Trichomoniasis is a sexually transmitted infection (STI). It is essential to educate the patient and ensure their sexual partner(s) are also treated to prevent reinfection and curb the spread of the infection.
Untreated trichomoniasis can increase a woman's risk of acquiring HIV if exposed and can lead to adverse pregnancy outcomes, such as preterm birth and low birth weight.

How to Approach the Question

This is a clinical scenario question that requires linking symptoms to a diagnosis and then to a specific laboratory finding.
First, identify the key signs and symptoms in the patient's presentation: 'frothy green discharge' and 'intense pruritus'.
Recall the classic presentations of the three common causes of vaginitis: Trichomoniasis, Bacterial Vaginosis, and Candidiasis.
The described symptoms strongly align with Trichomoniasis.
Next, recall the characteristic microscopic finding for Trichomoniasis.
Evaluate the options. 'Motile flagellate organisms' is the textbook description of T. vaginalis as seen on a wet mount.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of vaginitis based on clinical presentation and microscopic findings.
Stem keywords: frothy green vaginal discharge, intense pruritus, negative Whiff test, microscopy
Lead-in keywords: What is seen
Clinical cues: The combination of 'frothy green discharge' and 'intense pruritus' is a classic presentation for Trichomoniasis.

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E6 Medicine Davidson Principles Practice 24e p. 355-357

E6 Medicine Harrison 22e Part 1 p. 1142-1144

Practise the full INI-CET EXAM -2026

Attempt every question from this paper in a timed mock, then review the full solution for each one.