Trichomonas hominis

Trichomonas
Trichomonas vaginalis
TRICHOMONAS

Trichomonas differ from other flagellates as

they lack the cyst stage.
They exist as only trophozoites.
Three species of Trichomonas infect humans,
they are:
1. Trichomonas vaginalis is the only pathogen. It
resides in the genital tract
2. Trichomonas hominis: Non-pathogen, resides in
large intestine
3. Trichomonas tenax: Non-pathogen , resides in
mouth (teeth and gum )
Trichomonas vaginalis
It is the most common parasitic cause of
sexually transmitted diseases (STDs).
Females are commonly affected more than
males
It was first observed by Donne in 1836 from the
purulent genital discharge of a female
Though it is an eukaryote, its metabolism is
similar to a primitive anaerobic bacteria
Carbohydrate is utilized fermentatively.
It is unable to synthesize fatty acid, sterols,
purines and pyrimidines and hence depends on
exogenous sources.
Morphology
Trophozoites are the only stage, there is no
cystic stage.
Trophozoites
It is pear (pyriform) shaped, measures 7x15
μm
It is an oval or pear shaped, and it becomes
more amoeboid appearance when attached to
vaginal epithelial cells
It shows characteristic jerky motility in saline
mount preparation
It bears five flagella—four anterior flagella
and one lateral flagellum called as recurrent
flagellum as it curves back on the surface of the
parasite and traverses as undulating membrane.
It has a single nucleus containing central
karyosome.
Habitat:
•The parasite lives on the mucosa feeding on
bacteria and leucocytes.
•T. vaginalis is an obligate parasite. It cannot
live without association with the tissues
•In females, it lives in vagina
and cervix , urethra, and
urinary bladder.

•In males, it occurs mainly in

the anterior urethra, but may
also be found in the prostate .
Transmission
Infections with T. vaginalis occur worldwide.
The primary mode of transmission of the T. vaginalis
trophozoites is sexual intercourse.
These trophozoites may also migrate through a mother’s
birth canal and infect the unborn child.
Under optimal conditions, T. vaginalis is known to be
transferred via contaminated toilet articles or
underclothing, however, this mode of transmission is rare.
 The sharing of douche supplies, as well as communal
bathing, are also potential routes of infection.
T. vaginalis trophozoites, which are by nature hardy and
resistant to changes in their environment, have been known
to survive in urine, on wet sponges, and on damp towels for
several hours, as well as in water for up to 40 minutes.
Life Cycle
Life cycle of T. vaginalisis completed in a single host
either male or female.
Trophozoites are the infective stage as well as the
diagnostic stage.
Asymptomatic females are the reservoir of infection
and transmit the disease by sexual route
Trophozoites divide by longitudinal binary fission
giving rise to a number of daughter trophozoites in the
urogenital tract which can infect other individuals.
•Trichomonads do not encyst, although rounded,
nonmotile forms are observed which are degenerated
stages.
•Incubation period is roughly 10 days.
pathogenesis
Trichomonas vaginalis is facultative
anaerobic parasite. It produces energy by
fermentation of sugars in a structure
called Hydrogenosome.
A modified mitochondria in which
enzyme of oxidative phosphorylation is
replaced by enzyme of anaerobic
fermentation
Normal vaginal environment has a pH
around 3.8~4.4 and a healthy epithelium,
rich in glycogen.
The lactobacillus convert glycogen into
lactic acid, which in turn keeps the environ
acidic and this environment is not suitable
to growth T. vaginalis and other
pathogenic organisms.
 lactobacilli
Glycogen Lactic acid
keeping pH 3.8~4.4

T. vaginalis
Glycogen Non-lactic materials

elevating pH over than 5

When the pH is elevated to 6, the bacilli are

reduced in number and T.vaginalis flourish best.
Predisposing factors for trichomoniasis:
Binding to the vaginal epithelium by various
metabolic enzymes secreted by the trophozoites
like adhesins, proteolytic enzymes, iron
regulated proteins, erythrocyte binding proteins,
etc
Vaginal pH of more than 4.5 facilitates
infection
Hormonal levels
Co-existing vaginal flora
Strain and relative concentration of the
organisms present in the vagina
Clinical Features
Asymptomatic infection: 25–50% of individuals
are asymptomatic, harboring the trophozoites and
can transmit the infection
Acute infection (vulvo-vaginitis):
Females are commonly affected and are presented
as vulvo-vaginitis, characterized by profuse foul
smelling purulent vaginal discharge. Discharge may
be frothy (10% of cases) and yellowish green color
mixed with a number of polymorphonuclear
leukocytes
Strawberry appearance of vaginal mucosa (is
observed in 2% of patients. It is characterized by
small punctate hemorrhagic spots on vaginal and
cervical mucosa
Other features include dysuria and lower
abdominal pain
In males, the common
features are non-gonococcal
urethritis and rarely
epididymitis, prostatitis and
penile ulcerations

Chronic infection: In chronic

stage, the disease is mild with
pruritus and pain during coitus.
Vaginal discharge is scanty,
mixed with mucus
Complications:
Rarely it is associated with complications
like endometritis, infertility, low birth
weight and cervical erosions
There is also an association of increased
HIV transmission and cervical dysplasia
Respiratory distress may be seen in few
cases.
Laboratory diagnosis
Direct microscopy
Samples: Vaginal, urethral discharge, urine sediment and
prostatic secretions can be examined
Wet (saline) mounting of fresh samples (within 10–20 minutes
of collection) should be done to demonstrate the jerky motile
trophozoites and pus cells. Its sensitivity is variable (40–80%)
Permanent stain: Giemsa stain and Papanicolaou stain are
routinely performed to demonstrate the morphology
trophozoites
 Acridine orange fluorescent stain can be used. It is rapid and
sensitive; comparable to wet mount
Direct fluorescent antibody test (DFA): Trophozoites are
detected by staining with fluorescent labeled monoclonal
antibodies.
DAF test is more sensitive (70–90%) than wet-mount
examination.
Culture
Culture is the gold standard method for diagnosis. It is highly
sensitive 95% and specific (100%). It is positive even in
microscopy negative samples.
Cultures should be incubated for 3–7 days or longer, followed
by mounting of the culture to demonstrate the trophozoites
If facilities are available, special container like “InPouch TV”
can be used. It contains a specimen transport container, growth
chamber for incubation and a slide for mounting
Various culture medias can be used like:
1. Lash’s cysteine hydrolysate serum media
2. Diamond’s trypticase yeast maltose media
3. Cysteine peptone liver maltose media
4. Cell lines like McCoy cell line highly sensitive, can detect as
low as three trophozoites/ ml

Other Supportive Tests

Raised vaginal pH (> 4.5): It is not specific as the vaginal pH
is also raised in other pathogenic disease
Positive whiff test:
Fishy odor is accentuated when a drop of
10% KOH is added to vaginal discharge due to production of
amine
It is positive in more than 75% of cases
Excess of polymorphonuclear neutrophils on wet mount (seen
in more than 75% of cases).
Treatment:
•Metronidazole is highly effective therapeutic agent.
•In pregnancy, topical therapy with clotrimazole is
recommended.
•
Prevention:
Since infection is contracted through sexual intercourse,
therefore, the preventive measures include:
•Detection and treatment of case, both males and
females
•Avoidance of sexual contact with infected persons.
•Use of condoms.
•There is no vaccine currently available for use against
T. vaginalis.
Trichomonas tenax:

•It is a harmless commensal of the mouth, living

in the tartar around the teeth, in cavities of
carious teeth, in necrotic mucosal cells in the
gingival and in pus pockets in tonsillar crypts.

•In rare cases has been reported of respiratory

infection and thorax abscesses caused by T.
tenax mainly in patients with cancers or other
lung diseases
T. tenax (Trophozoites) transmitted by
kissing, salivary droplets
Pathogenesis
T. Tenax known to play a pathogenic role
in necrotizing ulcerative gingivitis

T. tenax may also be involved in the degradation

of peri-odontal tissue through the secretion of
substances such as alkaline phosphatases and
the fibronectin cathepsine.
T. tenax is classified as a parasite due to the
manner in which it causes damage to host tissues.
Diagnosis
•Can be made by demonstration of T. tenaxin
trophozoites in the tartar sample by microscopy

Trophozoites
 Therapy:-
•No therapy is indicated.
•Pain water or saline as hypotonic solutions
could cause the cells to lysis.

Prevention :-
•Better oral hygiene will rapidly eliminate
the infection
Trichomonas hominis:
•Trichomonas hominis resides in
the large intestine, It inhabits the
cecum of man, where it is regarded
as a commensal and is not known to
cause disease .
• They Feeds on enteric bacteria .
•They dose not invade the intestinal
mucosa .
•In freshly passed specimens, in
stools, the motility may be visible.
•In wet preparation,
look for the flagellar
movement from the
undulating membrane
and the presence of
the axostyle.

•Transmission occurs
by trophozoite form
Only trophozoites of T . hominis , secef ni dehs era
here is no known cyst stage for this species .
Infection occurs after the ingestion of trophozoites in
fecal-contaminated food or water.
Geographic Distribution:- Worldwide

Clinical Presentation:-
Trichomonas hominis is considered nonpathogenic.
The presence of trophozoites in stool specimens can be
an indicator of fecal contamination of a food or water
source, and thus does not rule-out other parasitic
infections.
Laboratory Diagnosis
Trichomonas hominis is identified through the
detection of trophozoites in stool specimens.
Identification is best accomplished by direct wet
mounts that detect the characteristic, jerky movement
of the organisms.
They may also be identified in permanent stained
smears, with their small size are often overlooked.

Treatment:-
This species is considered nonpathogenic, there are no
treatment recommendations for this organism.