Fourth parasitology lecture Dr. Zahraa Abd AL.

Hammza Abbass

THE GENUS TRICHOMONAS AND RELATED FORMS

Of the trichomonads that infect humans, two species, Trichomonas tenax and T. vaginalis,
possess four free, anterior flagella. A third species, formerly called T. hominis, has five free,
anterior flagella and is accordingly placed in the genus Pentatrichomonas. All trichomonads
possess certain common features, among which are three to five anterior flagella and a recurrent
flagellum in the form of an undulating membrane. All flagella in these forms originate from
anteriorly situated basal bodies. The costa also originates from the region of the basal bodies
and extends along the base of the undulating membrane. In all three species, associated with
the costa and/or axostyle is a row of granules, the hydrogenosomes (paracostal or paraxostylar
granules). An axostyle extending the length of the trichomonad appears to protrude from its
posterior end although it is covered by the plasma membrane. A prominent Golgi complex
(parabasal body) lies anteriorly near the single nucleus. There are no known cyst stages in the
life cycles of these organisms; while venereal or oral contact are obvious methods of
transmission for T. vaginalis and T. tenax, that of P. hominis remains obscure.

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Fourth parasitology lecture Dr. Zahraa Abd AL.Hammza Abbass

Trichomonas tenax

This flagellate is commonly found in the tartar and gums of the mouth, as well as in the
nasopharyngeal region. Trophozoites are very small (5-16 µm by 2-15 µm), with four free
flagella and a fifth flagellum re-curved as an undulating membrane that extends about two-
thirds of the length of the cell. The costa runs parallel to the undulating membrane.
Transmission is necessarily by direct contact, usually kissing or using contaminated eating
utensils. Drinking contaminated water from a community source may be another means of
transmission since some investigators have shown that this flagellate can live in drinking water
for several hours. The organism is not considered pathogenic and can be avoided through
proper oral hygiene. Like Entamoeba gingivalis, it tends to flourish in unhealthy environments
fostered by poor oral hygiene and is most easily found in patients who practice poor hygiene.

Trichomonas vaginalis

Of the three human-infecting trichomonads, T. vaginalis is the only pathogen, although a heavy
infection of Pentatrichomonas hominis may cause diarrhea. T. vaginalis inhabits the vagina in
the female and the urethra, epididymis, and prostate gland in the male. Morphologically, it is
distinguishable from the other two trichomomads by its larger size (7-32 µm by 5-12 µm) and
its shorter undulating membrane, which extends only one third the length of the cell. The
trophozoite occasionally produces pseudopodia. Clusters of hydrogenosomes extend along
both the costa and the axostyle.

T. vaginalis
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Fourth parasitology lecture Dr. Zahraa Abd AL.Hammza Abbass

Life Cycle

Typical of flagellates, T. vaginalis reproduces by longitudinal binary fission. The optimum pH

range for the organism to reproduce is approximately 5 or 6. While the normal pH of the vagina
is 4 to 4.5, when the level of acidity is disturbed, an environment is created in which T. vaginalis
thrives. Normally, the pH of the vagina is maintained by the activity of a group of lactic acid-
producing bacteria, but T. vaginalis can disrupt such bacteria, causing the pH to rise above 4.9.

Life cycle of T. vaginalis

Epidemiology

The prevalence among women is approximately 10 to 25%, varying inversely with the level of
hygiene practiced. While about 15% of women with trichomoniasis complain of symptoms,
altered vaginal secretions are evident in many more. In infected households, the recorded
incidence of infection among men is much lower than among women from the same household.
This statistic is misleading, however, since the flagellate is much more difficult to detect in
men; in fact, positive identification sometimes requires the examination of prostate exudate.
Transmission is by direct contact, usually through sexual intercourse. Damp washcloths and

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Fourth parasitology lecture Dr. Zahraa Abd AL.Hammza Abbass

similar items also are sources of infection among children and adults, viable trophozoites
having been recovered from wet washcloths 24 hours after contamination. Trichomoniasis
among newborns indicates that the fetus can acquire the organism while passing through the
birth canal.

Symptomatology and Diagnosis

Trichomonas vaginalis produces deterioration of the cells of the vaginal mucosa, resulting in
low-grade inflammation and persistent vaginitis. The condition is characterized by a yellowish
discharge accompanied by persistent itching and burning. In males, symptoms are much less
noticeable, although there may be urethritis and swelling of the prostate gland. These symptoms
are sometimes confused with gonorrhea. Diagnosis in females is confirmed by microscopical
identification of motile trophozoites in vaginal discharge smears. Examination of the urine of
both sexes and examination of prostate secretions of the male following prostate massage are
also helpful diagnostic procedures.

Chemotherapy

Metronidazole is the most effective drug, although it is contraindicated in pregnant patients.

Restoration of the normal pH of the vagina by periodic douches with a dilute solution of vinegar
is an effective preventive method and can control mild infections.

Pentatrichomonas (Trichomonas) hominis

This trichomonad is a smaller (5-14 µm by 7-10 µm), highly motile organism with an anterior
cytostome and three to five free flagella. Typically, four flagella beat synchronously, while the
fifth beats independently. A sixth, a recurrent flagellum, is associated with the undulating
membrane and extends the length of the cell, the flagellum protruding beyond the posterior end
as a trailing flagellum. P. hominis is generally considered a nonpathogen of the human colon,
and while it is often associated with diarrhea, there is no definite evidence that it causes the
condition. P. hominis has no cyst stage; so, transmission must occur via trophozoites, and flies
may be implicated as mechanical vectors. The ability of trophozoites to survive for at least 24
hours in feces-contaminated milk suggests that transmission may occur through contaminated
food and drink and that trophozoites are able to withstand the acidic environment of the
stomach en route to the intestine. Reproduction is by longitudinal fission. P. hominis infects
dogs, cats, and mice and other rodents, with such hosts serving as reservoirs in nature.
Identification of trophozoites in fresh fecal preparations provides the most accurate means of

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Fourth parasitology lecture Dr. Zahraa Abd AL.Hammza Abbass

diagnosis. It is important that only fresh samples be used since old stools may contain atypical
or degenerating trophozoites resembling amoebae, which could result in their misidentification.