Differentials

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Signs and symptoms of cervical or male urethral discharge are generally more pronounced with gonorrhea.

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Nucleic acid amplification test (NAAT) for gonorrhea alone is positive. May see gram-negative intracellular diplococci on Gram stain of infected specimens.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Vaginal discharge tends to be thin and have a fishy odor.

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Clue cells will be present on microscopic examination.

Vaginal pH >4.5.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Vaginal discharge may be thick and white in the vaginal vault. External genital symptoms such as itching and burning are more likely.

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Hyphae or budding yeast present on microscopic examination of KOH (potassium hydroxide) preparation of vaginal secretions.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Men tend to be asymptomatic but can be carriers. Women classically have a thin, grayish, frothy vaginal discharge in the vaginal vault. Discharge tends to be worse right after menses. The cervix, rarely, may be inflamed and have a strawberry appearance.

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Mobile trichomonads present on microscopic examination in many cases.

Nucleic acid amplification tests (NAATs) are now available.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Caused by the organism Mycoplasma genitalium. Frequently asymptomatic; however, can cause cervicitis and PID in women, and urethritis in men.

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Nucleic acid amplification test (NAAT) for M genitalium is available but is not yet in widespread use.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

A wide range of bacterial infections, including chlamydia, can ascend the female reproductive tract, causing pelvic or abdominal pain, fevers, nausea/vomiting, dyspareunia, and intermenstrual bleeding. Diagnostic criteria for PID include cervical motion tenderness and/or adnexal tenderness. The diagnosis is presumed when chlamydial infection and cervical motion tenderness coexist.

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There are no differentiating tests. PID is a clinical diagnosis.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Patients with persistent urethritis symptoms who did not comply with the treatment regimen or who were re-exposed to an untreated sex partner can be retreated with the initial antibiotic regimen. True treatment failures after treatment for genital tract chlamydia are rare. Reinfection is more likely. The most common cause of recurrent or persistent urethritis is Mycoplasma genitalium, especially following treatment with doxycycline. Less common causes include Ureaplasma urealyticum and Trichomonas vaginalis.

INVESTIGATIONS

Nucleic acid amplification test (NAAT) for M genitalium is available but is not yet in widespread use. Polymerase chain reaction (PCR) can be used to detect U urealyticum DNA from a urine sample or a vaginal swab. In the US, some laboratories have performed the necessary Clinical Laboratory Improvement Amendments (CLIA) of the Centers for Disease Control and Prevention validations and can perform nucleic acid amplification tests (NAATs) for T vaginalis detection.

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