In a patient with dysuria, vulvovaginal pruritus, and a frothy discharge, which finding would be expected on a saline preparation?

• A. Clue cells visible on saline preparation
• B. Hyphae and budding yeast on KOH preparation
• C. Intracellular Gram-negative diplococci on Gram stain
• D. Motile, flagellated protozoa on saline preparation

Answer: (D)

Dysuria with vulvovaginal pruritus and a frothy discharge points to infection with Trichomonas vaginalis, a flagellated protozoan. On a saline saline wet mount, the hallmark finding is motile, pear-shaped trophozoites that have flagella and move actively. This motility is what sets trichomonas apart from other vaginal infections.

Clue cells seen on saline indicate bacterial vaginosis, not a motile protozoan. Hyphae and budding yeast on a KOH prep point to vulvovaginal candidiasis. Intracellular Gram-negative diplococci on Gram stain would suggest gonorrheal infection. The presence of motile, flagellated protozoa on saline directly corresponds to Trichomonas infection, which matches the clinical picture.