Trichomonas vaginalis

• First described by Alfred Donne (1836)

• Dwells the urogenital tract

• Division= simple binary fission
• The only truly sexually transmitted parasitic
infection
• Only Trophozoite stage
1
 General morphology

• Varies in size & shape

– 7-23 μm x 5-15 μm
• Physiochemical conditions alter the appearance of
the parasite
• Axenic culture: trophozoites tend to be more
uniform
– pear shaped or oval
• Vaginal epithelial cells: takes on a more amoeboid
appearance

2
• Fig. 1. (A) T. vaginalis
parasite as seen in broth
culture. The axostyle,
undulating membrane, and
flagella are clearly visible
• (B) T. vaginalis on the
surface of a vaginal
epithelial cell prior to
ameboid transformation
• (C) Ameboid morphology of
T. vaginalis as seen in cell
culture

3
• Nucleus: anterior

• 5 flagella
– 4 anterior

– 5th flagellum is
incorporated within the
undulating membrane
• UM runs 2/3rd of the body
• Motility: quivering
4
 Trichomonas vaginalis
• infection occurs in every continent and climate
– all racial groups & socioeconomic strata
• > 170 million cases worldwide
• ~56% in patients attending STD clinics
• The rate depends on :
– Age (20-45)
– sexual activity
– number of sexual partners
– phase of the menstrual cycle
– techniques of examination 5
Epidemiology
• Prevalence ranges from 2% to >50% (region, country,
gender and demographics of the population)
• In developing countries: 5% –20%(women) and 2% –
10% (men)
• High prevalence corresponds to period of maximum
sexual activity (lower before puberty and post
menopause)
• High in black population
• Also in strictly monogamous couples

6
Pathogenesis…con’d
• Hormonal influence
– Nature of vaginal epithelium and resident flora are
affected by hormonal status
– During puberty
• Vaginal stratified squamous epithelial cells are
rich in glycogen
• Microbial flora are dominated by lactobacilli
• PH is low (~4.5)
• High redox potential

7
Pathogenesis…con’d
• Neonates
– Glycogen-rich stratified

epithelial cells Colonization in

neonates
– No lactobacilli

8
T.vaginalis
• Life cycle & transmission
– Sexual intercourse- 1o mode
– Communal bathing, toilet seats, shared
towel, overcrowded conditions)-rare
– Rarely infants may be infected by
passage through the mother’s infected
birth canal
9
Pathogenesis…con’d
• Virulence factors
– Adherence
• AP65,51,33 & 23
– Proteolysis
– Hemolysis: Pore-forming proteins
– Contact- mediated cytotoxicity
– Cell _Detaching Factor(CDF)

10
 Clinical manifestations
• ranges from the asymptomatic carrier state to flagrant
vaginitis
• Established infection persists for long periods in females
– only for a short time in males
• It is chiefly a disease of the reproductive years
– clinical manifestations are rarely observed before
menarche or after menopause
• Incubation period: 4 to 28 days
• severity of the infection
– acute, chronic

11
 Clinical manifestations cont’d
• Acute infection:
– Diffuse vulvitis due to copious leukorrhea
– typically frothy, yellow or green discharge
– Small punctate hemorrhagic spots (vaginal & cervical)
• “strawberry appearance”
– cyclic and worsen around the time of menses
• Chronic infection:
– the predominant symptoms are mild, with pruritus and
dyspareunia
– scanty vaginal secretion mixed with mucus
– these individuals are the major source of transmission
12
 Clinical features
• Symptoms in Women
– Itchiness in the genitals & burning sensation, white,
gray, or green, frothy Foul smelling discharge
– Pain while urination
– Pain during sexual intercourse
– Redness and swelling in the genital area
– Constant urge to urinate
– colptis macularis (strawberry cervix)-colposcopy-
diffuse/patchy erythematois lesions on ectocervical
epithelium
13
Clinical features
• Symptoms in Men (Rare)
– Pain and burning sensation during
urination
– Discharge from the urethra
– Pain during ejaculation
– Irritation and itchiness inside the penis
– Constant urge to urinate
14
 Sequelae of TV
• Reproductive outcomes
– Studies show an association between TV
and vaginitis, cervicitis, urethritis, bacterial
vaginosis, candidiasis, herpes simplex virus,
and syphilis
– TV has also been associated with poor birth
outcomes
• low birth weight, preterm delivery, pelvic
inflammatory disease, and premature
rupture of membranes
15
 HIV acquisition & transmission
• A higher risk for HIV acquisition
• This susceptibility is biologically plausible
i. Inflammatory responses results in the increased
appearance of HIV target cells
ii. TV infection can impair the mechanical barrier
to HIV via mucosal hemorrhages
iii. TV infection may change the normal vaginal
flora rendering it more permissive for bacterial
vaginosis & hence increase the risk of HIV
acquisition
16
Diagnosis
• Microscopy:
– vaginal or cervical secretions
– sensitivity (38% -82%)
• loss of distinctive motility out of body temperature
• Culture: Diamond medium
• Slow
• Staining techniques:
– acridine orange, Leishman, periodic acid- Schiff,
Fontana, Papanicolaou (Pap) staining
– rounded forms resembling polymorphonuclear
leukocytes
17
Treatment
• Treatment
– Metronidazole
• 500mg b.i.d x 7 days or 2g P.O. single dose
– Tinidazole, 2gm PO as a single dose
• Prevention
– both male & female sex partners must be treated
to avoid reinfection
– good personal hygiene, avoidance of shared toilet
articles & clothing.
– safe sexual practice 18