TRICHOMONAS VAGINALIS INFECTION

Definition:

 Trichomoniasis is an infection of the vagina or male genital tract with

trichomonas vaginalis

Etiology:

 T. vaginalis is a flagellated protozoan found in the GU tract of both men

and women
 Trichomonas vaginalis is a pear shaped protozoan which is a facultative
anaerobe.
 It is usually sexually transmitted although a non-venereal route is
possible as the organism survives for several hours in a moist
environment.
 The organism is more common in women, affecting about 20% during
the reproductive years and causing vaginitis, urethritis, and possibly
cystitis.

Signs and symptoms:

Female
 About 50% of women who harbor the organism are asymptomatic
 Symptoms typically begin or worsen at time of menstrual period
 Vaginal discharge (75%, usually copious, which may be frothy,
yellowish green and alkaline, watery and pooling)
 Vulvovaginal irritation (50%)
 Dysuria (50%)
 Vaginal odor (10%)
 A "strawberry cervix" from punctate hemorrhages (5% of cases)
 Vaginal hyperemia
 Dyspareunia
 Suprapubic discomfort
 Cervical erosion

Male
 Most are asymptomatic
 Symptomatic (20%)
 Urethral discharge
 Dysuria
 Epididymitis (rare)

Diagnosis

 Trichomoniasis in women is diagnosed by microscopic examination of a

fresh sample of the vaginal discharge mixed in one to two drops of
normal saline.
 Motile protozoans are usually easily identified.

Treatment

 Metronidazole 500 mg bid for 7 days or a single dose of 2 g po

(acceptable as treatment in pregnant women according to the CDC) may
be used.
 Effectiveness of single-dose regimens in men is less clear, so men may
be treated with 500 mg bid for 7 days, especially if a single dose is not
curative.
 Clinical and microbiologic resistance to metronidazole occurs and may
require high-dose IV or topical therapy.
 Adverse effects include nausea and a metallic taste; severe nausea with
vomiting is more common with the single dose.
 The patient's sexual partner should be treated.
 Some strains of T. vaginalis have diminished susceptibility to
metronidazole but respond to higher doses.
 Treat patients with repeated treatment failures with metronidazole
(Flagyl) 2 g po once a day for 3 to 5 days