TRICHOMONIASIS A protozoal infection, trichomoniasis affects about 15% of sexually active females and 10% of sexually active males.

Common sites of infections in females include the vagina, urethra and, possibly, the endocervix, bladder, Bartholins glands, or Skenes glands; in males, the lower urethra and, possibly, the prostate gland, seminal vesicles, or epididymis. It may be transmitted by an asymptomatic carrier who harbors the organism in the urogenital tract. It may increase the risk of contracting HIV from an infected partner.

Causes: Trichomonas vaginalis, a tetraflagellated, motile protozoan Clinical Manifestations: Vaginal discharge that is thin (sometimes frothy) yellow to yellow-green, malodorous, and very irritating. Severe itching, redness, swelling, dyspareunia, dysuria; occasionally, postcoital spotting, menorrhagia, dysmenorrheal. An accompanying vulvitis may result, with vulvovaginal burning and itching. STRAWBERRY SPOTS multiple small petechiae.

Complications: - Trichomoniasis is associated with increased risk of transmission of HIV. - may cause a woman to deliver a low-birth-weight or premature infant. - also associated with increased chances of cervical cancer - evidence implies that infection in males potentially raises the risks of prostate cancer development and
spread due to inflammation.

Diagnostic tests: - Microscopic examination of vaginal or seminal discharge or urine specimen is positive for T. vaginalis. - Inspection with a speculum often reveals vaginal and cervical erythema (redness) with multiple small petechiae (strawberry spots). - pH testing of a trichomonal discharge will demonstrate a pH greater than 4.5. Treatment: - Metronidazole (both partners receive a one-time loading dose and a smaller dose three times a day for 1 weeek. The one time dose is more convenient; consequently, compliance tends to be greater. The week long treatment has occasionally been noted to be more effective. Nursing Management: - Some patients complain of an unpleasant but transient metallic taste when taking metronidazole. Nausea and vomiting, as well as a hot, flushed feeling, occur when this medication is taken with an alcoholic beverage (disulfiram-like reaction). In view of this side-effect, the patient is strongly advised to abstain from alcohol while taking this medication.

Metronidazole therapy is contraindicated in patients with some blood dyscrasias or central nervous system diseases, in the first trimester of pregnancy, and in women who are breastfeeding.