Trichomonas vaginalis

Clinical signs of Trichomonas vaginalis include a frothy grey/green discharge at the posterior fornix. There may also classically be pedunculated red patches observable on the cervix. This is known as a 'strawberry cervix' by analogy with strawberry patches.

Diagnosis should not rely on clinical signs alone, however, as these lack specificity; the use of a valid and reliable test that is sensitive and specific to a particular infection is essential to accurate and effective management. Careful swab technique (according to the manufacturer's instructions) and appropriate and timely storage and transfer of specimens ensure that this is maximised.


Women with a cervical polyp may present with vaginal discharge, which may be brownish or bloodstained. On examination, polyps may be seen protruding from the cervical os. The woman should be referred to gynaecology for assessment and excision.


A red appearance of the cervix is not necessarily pathological, but may be due to the outward movement of the transformation zone under the influence of high circulating levels of oestrogen, particularly in young women or those taking the combined oral contraceptive pill. The soft, mucus-producing columnar cells that usually line the endocervical canal are seen on the outside of the cervix: this is known as 'ectopy' or 'an ectropian', and is a normal physiological variation. For some women, however, it may be associated with increased physiological discharge or with contact bleeding (for example, after sex). Information should be given, which may provide reassurance; however, the discharge may be particularly heavy and problematic for some women (for example requiring frequent changes of sanitary protection). Although a normal variation, symptoms can sometimes be improved through treatment with cold coagulation, which (paradoxically) uses heat to the cervix to destroy the cells physically. Where ectopy is problematic, referral to colposcopy is necessary for appropriate assessment prior to treatment.

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