Consider Trichomonas vaginalis in the Differential Diagnosis for Genital Ulcers

A 21-year-old immunocompromised female (advanced HIV, CD4 count: 9 cells/μL) presented with painful genital ulcers. A multiplex PCR panel detected Trichomonas vaginalis in both vaginal and ulcer swabs, while tests for Neisseria gonorrhoeae , Chlamydia trachomatis , and Mycoplasma genitalium were negative. The patient was treated with metronidazole, resulting in significant clinical improvement. This case underscores the importance of considering Trichomonas vaginalis in the differential diagnosis of genital ulcers, particularly in immunocompromised individuals, and highlights the utility of molecular testing in atypical presentations.