Atypical Mixed Trichomoniasis and Ureaplasma Urealyticum Infection Confirmed by Multiplex Real-Time PCR: A Case Report

Abstract

Trichomonas vaginalis and Ureaplasma urealyticum are prevalent sexually transmitted pathogens with complex symbiotic interactions. Classically, trichomoniasis presents with profuse, frothy vaginal discharge, while U. urealyticum causes urethritis or remains asymptomatic. An isolated genital ulcer without discharge is an exceedingly rare and atypical presentation for both. A sexually active female presented with acute dysuria and a solitary, painful external vulvar ulcer. Examination revealed localized erythema but a complete absence of purulent or frothy vaginal discharge. Due to this atypical morphology, Multiplex Real-Time PCR was utilized, definitively confirming a mixed T. vaginalis and U. urealyticum infection. The patient received targeted therapy comprising Azithromycin (1-gram single dose) and a 7-day multi-dose Metronidazole regimen (500 mg twice daily), alongside Omeprazole. This intervention achieved rapid, complete resolution of the ulcer and symptoms. This case highlights that synergistic protozoan-bacterial infections can bypass classic syndromic paradigms, presenting as localized genital ulcers mimicking viral or treponemal etiologies. The absence of characteristic discharge likely stems from endosymbiont-driven, highly localized mucosal necrosis. Clinicians must expand differential diagnoses for atypical ulcers and utilize Multiplex PCR for accurate detection and targeted therapy