Trichomonas Vaginitis or Trichomoniasis is a sexually transmitted infection caused by the protozoa Trichomonas vaginalis Trichomonas Vaginitis is an infection caused

by a one-celled protozoan called trichomonas. This is an extremely common cause of vaginal infections. Trichomonas Vaginitis is also known as, trichomoniasis, trichomonas vaginalis Trichomoniasis in women may be asymptomatic or may cause various symptoms, including a frothy yellowgreen vaginal discharge and vulvar irritation. Men with trichomoniasis are frequently asymptomatic. The high incidence of T vaginalis infection worldwide and coinfection with other sexually transmitted infections make trichomoniasis a compelling public health concern. Notably, T vaginalis infection is believed to increase the risk of HIV transmission. Trichomoniasis is also associated with adverse pregnancy outcomes, infertility, postoperative infections, and cervical neoplasia.

from the vagina, cervix, urethra, bladder, and Bartholin and Skene glands. In men, the organism is found in the anterior urethra, external genitalia, prostate, epididymis, and semen.

Frequency International Worldwide, the annual incidence of trichomoniasis is about 170 million cases. Mortality/Morbidity T vaginalis infection is highly associated with the presence of other sexually transmitted infections, including gonorrhea, chlamydia, and sexually transmitted viruses. T vaginalis infection increases the susceptibility to others viruses, including herpes, human papillomavirus (HPV), and HIV. Persons with trichomoniasis are twice as likely to develop HIV infection as the general population. Two explanations exist for the association between T vaginalis and HIV: (1) Disruption of the epithelial monolayer leads to increased passage of the HIV virus; (2) T vaginalis induces immune activation, specifically lymphocyte activation and replication and cytokine production, leading to increased viral replication in HIV-infected cells. In men, complications of untreated trichomoniasis include prostatitis, epididymitis, urethral stricture disease, and infertility. Infertility may result from a decreased sperm motility and viability. Race Evidence suggests that T vaginalis infection most likely increases HIV transmission. Thus, the observed higher prevalence of T vaginalis infection in

Pathophysiology T vaginalis is approximately the size of a white blood cell (about 10 μm in diameter), although its size may vary with physical conditions. Its flagellum allows it to move around vaginal and urethral tissues. T vaginalis directly damages the epithelium, leading to microulcerations of inhabited tissues, increasing the risk of HIV transmission. Symptoms of trichomoniasis typically occur after an incubation period of 4-28 days. In women, T vaginalis is isolated

African Americans is cause for concern. Lower-abdominal tenderness may be present. Although T vaginalis may increase the risk of HIV transmission by only a small to moderate amount. describes a diffuse or patchy macular erythematous lesion of the cervix. Men Trichomoniasis symptoms in men range from none to urethritis complicated by prostatitis. Age Trichomoniasis is a sexually transmitted infection. this is particularly disconcerting since it increases the susceptibility to other viruses. Clinical History Women Trichomoniasis symptoms in women range from none to severe pelvic inflammatory disease. many infected women experience no symptoms. Complications of untreated trichomoniasis: • • • • Prostatitis Epididymitis Urethral stricture disease Infertility Physical Women • • • • • a frothy yellowish-green vaginal discharge abnormal vaginal odor vulvovaginal itching and soreness. however. is detected in up to 45% of cases. dyspareunia (pain during sexual intercourse) dysuria (pain during urination) • • Purulent or homogenous vaginal discharge and vulvar or vaginal erythema are common. this is . In female adolescents. it is typically found in sexually active adolescents and adults. Nongonococcal nonchlamydial urethritis is the most common symptom reported by men with trichomoniasis. Symptoms of urethritis include: • • • • Discharge Dysuria Urethral pruritus The discharge may be purulent to mucoid in character Most symptomatic infections are intermittent and self-limiting. As such. particularly among African Americans. Women with trichomoniasis frequently report: • However. or strawberry cervix. Sex Symptomatic trichomoniasis is more common in women than in men. control of T vaginalis may represent an important means of slowing HIV transmission. Colpitis macularis. trichomoniasis is more common than gonorrhea. Therefore. Trichomoniasis infection in men is less clinically apparent. its high prevalence in the African American community makes it a cause of measurable increase in rates of HIV transmission.

but specificity is limited and the slide should be evaluated immediately. A vaginal swab sample for saline wet mount evaluation is an easy. Trichomonas vaginalis on a saline wet mount at 40X on the microscope. Histologic Findings . Physical findings of epididymitis and prostatitis may also occur. the pH of vaginal secretions measured on Nitrazine paper is often elevated (>4.5). Polymerase chain reaction (PCR) methods yield a high sensitivity (84%) and specificity (94%). Saline microscopic examination • • • Vaginal trichomoniasis is typically diagnosed with microscopy. surrounded by white blood cells and squamous epithelial cells. Bacterial vaginosis frequently also elevates the pH. urine. and samples without growth after 7 days are considered negative for trichomoniasis. Urethral swab. Disadvantages of culture method include testing time and availability. Swab is put in broth and incubated anaerobically at 37°C. Growth is usually detected within 48 hours. and semen cultures are used to maximize sensitivity. Standard culture • • Laboratory Studies Laboratory studies aid in demonstration of the T vaginalis organism and are used to differentiate trichomoniasis from bacterial or fungal infection. Culture yields a sensitivity of about 95%. Upon application of 10% potassium hydroxide to a vaginal swab sample in the potassium hydroxide (KOH) amine test. It may be associated with local inflammatory states. an elevation in pH is not highly specific. False-positive results are also common with this technique. but this test yields low sensitivity and should not be relied on for diagnosis (50%). Culture is more sensitive and specific than microscopy. a fishy odor is released. However. which can suggest trichomoniasis or bacterial vaginosis. and economical tool. PCR has great diagnostic potential. valuable. Papanicolaou (Pap) smear • Trichomonads may be viewed on Papanicolaou (Pap) smear. Several motile parasites transit through the field.described in fewer than 10% of patients Men • • • The findings of trichomoniasis in men on physical examination are generally unremarkable unless the infection is complicated. Polymerase chain reaction (nucleic acid amplification) • pH testing • In women with trichomoniasis. Culture is especially important for diagnosing trichomoniasis in men since the wet preparation findings are usually negative. including balanitis and balanoposthitis. Although not yet widely available.

although oral treatment is usually preferred. tinidazole. When standard treatment regimens fail. tinidazole. Medication The 5-nitroimidazole group of drugs includes antiprotozoal agents (metronidazole. . vaginal epithelium. correlating with the severity of the infection. a large number of PMNs are usually present. Treatment of the patient’s partner is crucial to avoid reinfection. povidone-iodine. Routine screening for trichomoniasis in asymptomatic pregnant women is not currently recommended. Treatment of sexual partners is thought to increase cure rates. Resistance to these drugs is rare despite their widespread use in the treatment of trichomoniasis and is typically solved by increasing the dose or switching to another nitroimidazole. The interaction of the drugs and alcohol may cause a disulfiramlike reaction. In clinical practice. however.Trichomonads may be observed in a saline wet mount of a vaginal swab or secretion in approximately 60-70% of women with trichomoniasis. Drugs may also be applied locally in the vagina or rectum. as trichomoniasis is an infection of multiple sites (eg. Oral metronidazole is the treatment of choice and has been demonstrated in multiple studies to offer efficacy that is superior to that of intravaginal treatment. nimorazole. metronidazole or tinidazole at 2 g PO for 5 days should be considered. Theoretically. The mechanism of action is not well understood. Systemic treatment is important to ensure a cure. Medical Care • Diet Instruct the patient to avoid alcohol while taking metronidazole. Drug resistance is rare. repeat testing at 5-7 and 30 days is recommended. carnidazole) used for the treatment of trichomoniasis. Because they cause an inflammatory reaction. Treatment failures may require a higher dose metronidazole regimen or the use of a different nitroimidazole. Skene glands. Treatment with oral metronidazole is not associated with preterm birth and is protective in women diagnosed with trichomoniasis at 35 weeks’ gestation or later. despite the prevalent use of nitroimidazole drugs in the treatment of trichomoniasis. anaerobic organisms preferentially reduce the 5nitro group. They are identifiable by to their ameboid mobility. or other nitroimidazole drugs. urethra). • • • • • • • • Prompt trichomoniasis diagnosis is important for eliminating infection in the patient and sexual partners. Trichomonads are ovoid in shape and slightly larger than PMNs. and active metabolites likely interact with anaerobic bacterial and protozoal DNA. Bartholin glands. Activity Patients should avoid sex until drug therapy is completed and all symptoms have disappeared. repeat testing is rarely performed unless symptoms do not improve with drug treatment. Local intravaginal medications include clotrimazole.

dark red spots (petechiae) on the cervix. The most common brand name is Flagyl. 2. the patient's sexual partner(s) must also be treated. Talk openly with your partner about STDs. hepatitis B infection and the use of contraception.and nonoxynol-9 (N-9). treating the female partner in a sexually active . including pelvic examination. Trichomonas organisms can be easily identified because they swim quite rapidly with their whip-like tails. Cause of Trichomoniasis Trichomonis can be transmitted through sexual intercourse.000 mg dose. Topical drugs other than nitroimidazoles yield low cure rates (<50%). Latex condoms used consistently and correctly are an effective means for preventing disease (and pregnancy). Diagnosis of Trichomoniasis A complete medical history and physical examination. a yellow or greenish frothy or bubbly discharge sometimes with a foul odor itching Prevention of Trichomoniasis All sexually active persons should consider using latex condoms to prevent STDs and HIV infection. or 500 mg twice daily every day for seven days. HIV. Metronidazole may also be applied vaginally or rectally to reach therapeutic concentrations in the blood. even if they are using another form of contraception. Usually. is performed. The dosage is usually a single. Symptoms of Trichomoniasis • • • • • couple is enough. However. soreness and inflammation of the vulva and inside the vagina. The physician will prepare a wet smear by mixing a sample of the vaginal discharge with a drop of salt solution (normal saline) and examining it under a microscope. if infection recurs. Treatment of Trichomoniasis The most effective drug for treatment of trichomonas is metronidazole. Trichomonas can also cause small.

Sign up to vote on this title
UsefulNot useful