August 23rd, 2019

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Trichomonas in Amniotic Fluid Leading to Chorioamnionitis with Intact Membranes: A Case Report
Authors:  Avni Segal, M.D., Syeda Rabia Ali, D.O., and Jay Goldberg, M.D.
BACKGROUND: Trichomonas vaginitis is the most common nonviral sexually transmitted infection in the United States. Symptoms include malodorous green, frothy vaginal discharge, dysuria, and spotting. Diagnosis is based on symptoms and physical examination findings.

CASE: A 19-year-old woman, gravida 2, para 0-0-1-0 at 28.4 weeks’ gestation presented complaining of abdominal pain and discharge. She had a cerclage in place due to cervical incompetence. She was diagnosed with trichomonas infection at 15 weeks’ gestation, she and her partner were treated. The patient had a workup for chorioamnionitis due to fundal tenderness. Amniocentesis was performed and confirmed chorioamnionitis. Trichomonas vaginalis was present in the amniotic fluid. The patient was treated for chorioamnionitis and trichomonas. Labor was induced and a spontaneous vaginal delivery occurred. The neonate had ruptured vesicular lesions on the abdomen, back, and penis and was treated for presumed sepsis and trichomonas infection. The infant was also treated for bronchopulmonary dysplasia, presumed meningitis, and pneumonia due to trichomonas.

CONCLUSION: Trichomonas vaginalis adheres to squamous epithelium of the vagina and may be transmitted to the neonate during vaginal delivery. Our patient, who had documented intact membranes, had trichomonas identified in amniotic fluid. The mechanism by which trichomonads penetrated the amnion and chorion are unknown.
Keywords:  amniocentesis, amniotic fluid, chorioamnionitis, pregnancy, sexually transmitted diseases, Trichomonas, Trichomonas infections, Trichomonas vaginalis, Trichomonas vaginitis
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