A 31-year-old woman has had vulvar pruritus along with a thick, whitish, odorless, globular vaginal discharge for the past week. On pelvic examination, the cervix appears erythematous, but there are no erosions or masses. A Pap smear shows budding cells and pseudo hyphae. No dysplastic cells are present. Which of the following infectious agents is most likely to produce these findings?: (A) Candida albicans, (B) Chlamydia trachomatis, (C) Neisseria gonorrhoeae, (D) Trichomonas vaginalis
Answer is A. The presence of the budding cells with pseudo hyphae indicates a fungal infection with Candida. Candidal (monilial) vaginitis is common; this organism is present in about 5% to 10% of women. Recurrent episodes of vaginal candidiasis may be associated with non-albicans species. The inflammation tends to be superficial, and there is typically no invasion of underlying tissues. Urea plasma is a bacterial agent, as is Chlamydia, and both can produce cervicitis. Neisseria gonorrhoeae, a gram-negative diplococcus, is the causative agent of gonorrhea. Infection with Trichomonas vaginalis can produce a purulent vaginal discharge, but the organisms are protozoa and do not produce hyphae.