Trichomoniasis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Trichomoniasis is a common sexually transmitted disease that affects 7.4 million previously unaffected Americans each year. Trichomonas vaginalis, the causative agent of trichomoniasis, is an anaerobic, flagellated protozoan parasite.^[1] Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.^[2] The parasite is sexually transmitted through contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.^[3][4] Trichomoniasis is primarily an infection of the genitourinary tract. The urethra is the most common site of infection in men, and the vagina is the most common site of infection in women. Trichomoniasis must be differentiated from other causes of vaginitis such as bacterial vaginosis, vulvovaginal candidiasis, and atrophic vaginitis.^[5] In 2008, the incidence of trichomoniasis was estimated to be 358 cases per 100,000 individuals in the United States.^[6] Females are more commonly affected with trichomoniasis than males.^[7] Common risk factors in the development of trichomoniasis include multiple sexual partners, unprotected sexual activity, intravenous drug use, and coexisting veneral disease.^[8][9] If left untreated, women with trichomoniasis may progress to develop infection of the adnexa, endometrium, and Skene and Bartholin glands. In men, untreated trichomoniasis can cause epididymitis, prostatitis, and decreased sperm cell motility.^[8] Complications of trichomoniasis include pelvic inflammatory disease, increased risk of HIV, increased risk of cervical cancer, increased risk of prostate cancer, and pregnancy-related complications such as low birth weight, preterm delivery, and premature rupture of membranes. The prognosis of trichomoniasis is generally excellent with treatment.^[10] The majority of women (85%) and men (77%) with trichomoniasis are asymptomatic. One-third of asymptomatic women become symptomatic within 6 months. Common symptoms of trichomoniasis in women include vaginal discharge (which is often diffuse, malodorous, and yellow-green or gray in color), painful urination (dysuria), vulvar irritation and itching, abdominal pain, and discomfort during sexual intercourse.^[8] Symptoms of trichomoniasis in men include clear or mucopurulent urethral discharge, painful urination, and pruritus or a burning sensation following sexual intercourse.^[9] Common physical examination findings of trichomoniasis include strawberry cervix and a foul-smelling, frothy, and mucopurulent green or gray vaginal discharge.^[11][12] In males, there may be scanty, mucopurulent urethral discharge.^[13] Laboratory tests used in the diagnosis of trichomoniasis include saline microscopy, culture, and nucleic acid amplification tests (NAATs).^[14] Antimicrobial therapy is the mainstay of treatment for trichomoniasis.

Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.^[2]

Trichomonas vaginalis, the causative agent of trichomoniasis, is an anaerobic, flagellated protozoan parasite.^[1] The parasite is sexually transmitted through contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.^[3][4]

Trichomoniasis is caused by the single-celled protozoan parasite Trichomonas vaginalis. The vagina is the most common site of infection in women, and the urethra is the most common site of infection in men.

Trichomoniasis must be differentiated from other causes of vaginitis such as bacterial vaginosis, vulvovaginal candidiasis, and atrophic vaginitis.^[5]

Trichomoniasis is the most common curable STD in young, sexually active women. An estimated 7.4 million new cases occur each year in the United States. In 2008, the incidence of trichomoniasis was estimated to be 358 cases per 100,000 individuals in the United States.^[6] Females are more commonly affected with trichomoniasis than males.^[7] Trichomoniasis usually affects African American individuals. Caucasian individuals are less likely to develop trichomoniasis. In the United States, the highest prevalence of trichomonas infection in women is observed among African-Americans, with rates ranging from 13–51%.^[8]

Common risk factors in the development of trichomoniasis include multiple sexual partners, unprotected sexual activity, intravenous drug use, and coexisting veneral disease.^[8][9]

If left untreated, women with trichomoniasis may progress to develop infections of the adnexa, endometrium, and Skene and Bartholin glands. In men, untreated trichomoniasis can cause epididymitis, prostatitis, and decreased sperm cell motility.^[8] Complications of trichomoniasis include pelvic inflammatory disease, increased risk of HIV, increased risk of cervical cancer, increased risk of prostate cancer, and pregnancy-related complications such as low birth weight, preterm delivery, and premature rupture of membranes. The prognosis of trichomoniasis is generally excellent with treatment.^[10]

It is critical to collect a detailed and thorough sexual history from the patient. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of trichomoniasis or other sexually transmitted diseases. The majority of women (85%) and men (77%) with trichomoniasis are asymptomatic. One-third of asymptomatic women become symptomatic within 6 months. Common symptoms of trichomoniasis in women include vaginal discharge (which is often diffuse, malodorous, and yellow-green or gray in color), painful urination (dysuria), vulvar irritation and itching, abdominal pain, and discomfort during sexual intercourse.^[8] Symptoms of trichomoniasis in men include clear or mucopurulent urethral discharge, painful urination, and pruritus or a burning sensation following sexual intercourse.^[9]

Patients with trichomoniasis are usually appear well. Common physical examination findings of trichomoniasis include strawberry cervix and a foul-smelling, frothy, and mucopurulent green or gray vaginal discharge.^[11][12] In males, there may be scanty, mucopurulent urethral discharge.^[13]

Laboratory tests used in the diagnosis of trichomoniasis include saline microscopy, culture, and nucleic acid amplification tests (NAATs).^[14]

Trichomoniasis can usually be cured with the prescription drug metronidazole, administered orally in a single dose. The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment. However, an infected man—even a man who has never had symptoms or whose symptoms have stopped—can continue to infect or re-infect a female partner until he has been treated. Therefore, both partners should be treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant women. Having had trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.

One effective measure for the primary prevention of trichomoniasis is abstinence from sexual contact. Latex male condoms, when used correctly and consistently, can reduce the risk of transmission of trichomoniasis. Any genital symptom such as discharge, burning during urination, or an unusual sore or rash should be taken as a signal to stop having sex and to consult one’s health care provider immediately.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.^[1]

Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Aysha Anwar, M.B.B.S[3]

Trichomonas vaginalis, the causative agent of trichomoniasis, is an anaerobic, flagellated protozoan parasite.^[1] The parasite is sexually transmitted through contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.^[2][3]

Trichomonas vaginalis, the causative agent of trichomoniasis, is an anaerobic, flagellated protozoan parasite.^[1] The vagina is the most common site of infection in women, and the urethra is the most common site of infection in men. The parasite is sexually transmitted through contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.^[2][3]

• Resides in the female lower genital tract and the male urethra and prostate
• Replicates by binary fission
• Does not appear to have a cyst form, and does not survive well in the external environment
• Transmission occur among humans, its only known host, primarily by sexual intercourse

A draft sequence of the Trichomoniasis genome was published on January 12, 2007 in the journal Science, confirming that the genome has at least 26,000 genes, a similar number to the human genome.^[4]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Trichomonas vaginalis, an anaerobic, parasitic flagellated protozoan, is the causative agent of trichomoniasis, and is the most common pathogenic protozoan infection of humans in industrialized countries.^[1] The WHO has estimated that 180 million infections are acquired annually worldwide. The estimates for North America alone are between 5 and 8 million new infections each year, with an estimated rate of asymptomatic cases as high as 50%.^[2]

T. vaginalis also has many enzymes that catalyze a number of reactions making the organism relevant to the study of protein function. T. vaginalis lacks mitochondria and other necessary enzymes and cytochromes to conduct oxidative phosphorylation. T. vaginalis obtains nutrients by transport through the cell membrane and by phagocytosis. The organism is able to maintain energy requirements by the use of a small amount of enzymes to provide energy via glycolysis of glucose to glycerol and succinate in the cytoplasm, followed by further conversion of pyruvate and malate to hydrogen and acetate in an organelle called the hydrogenosome.^[3]

The T. vaginalis trophozoite is oval as well as flagellated. Five flagella arise near the cytosome; four of these immediately extend outside the cell together, while the fifth flagellum wraps backwards along the surface of the organism. The functionality of the fifth flagellum is not known. In addition, a conspicuous barb-like axostyle projects opposite the four-flagella bundle; the axostyle may be used for attachment to surfaces and may also cause the tissue damage noted in trichomoniasis infections.^[4]

While T. vaginalis does not have a cyst form, organisms can survive for up to 24 hours in urine, semen, or even water samples. Combined with an ability to persist on fomites with a moist surface for 1 to 2 hours, T. vaginalis is among the most durable protozoan trophozites.

Trichomoniasis can occur in females (males rarely exhibit any symptoms of a T. vaginalis infection) if the normal acidity of the vagina is shifted from a healthy, semi-acidic pH (3.8 – 4.2) to a much more basic one (5 – 6) that is conducive to T. vaginalis growth. Some of the symptoms of T. vaginalis include: preterm delivery, low birth weight, and increased mortality as well as predisposing to HIV infection, AIDS, and cervical cancer.^[5] T. vaginalis has also been reported in the urinary tract, fallopian tubes, and pelvis and can cause pneumonia, bronchitis, and oral lesions. Other symptoms include inflammation with increasing number of organisms, greenish-yellow frothy vaginal secretions and itching.

T. vaginalis can be detected by studying discharge or with a pap smear and culturing. With a pap smear, infected individuals would have a transparent “halo” around their superficial cell nucleus. T. vaginalis is diagnosed via a wet mount, in which “corkscrew” motility can be observed. Condoms are effective at preventing infection.

Metronidazole or tinidazole can treat an infection in progress, and should be prescribed to sexual partners as well.^[6].

Jane Carlton led a project to sequence the Trichomonas vaginalis genome which found that the genome was much larger than was expected.[2] [3]

• TIGR’s Trichomonas vaginalis genome sequencing project.
• TrichDB: the Trichomonas vaginalis genome sequencing project
• NIH site on trichomoniasis.
• Taxonomy

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cs:Bičenka poševní da:Trichomonas vaginalis de:Trichomonas vaginalis it:Trichomonas nl:Trichomonas vaginalis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Trichomoniasis must be differentiated from other causes of vaginitis such as bacterial vaginosis, vulvovaginal candidiasis, and atrophic vaginitis.^[1]

Trichomoniasis must be differentiated from other causes of vaginitis such as:^[1]

• Bacterial vaginosis
• Vulvovaginal candidiasis
• Atrophic vaginitis

Trichomoniasis must also be differentiated from:

• Syphilis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Aysha Anwar, M.B.B.S[3]

Trichomoniasis is the most common curable STD in young, sexually active women. An estimated 7.4 million new cases occur each year in the United States. In 2008, the incidence of trichomoniasis was estimated to be 358 cases per 100,000 individuals in the United States.^[1] Females are more commonly affected with trichomoniasis than males.^[2] Trichomoniasis usually affects African American individuals. Caucasian individuals are less likely to develop trichomoniasis. In the United States, the highest prevalence of trichomonas infection in women is seen among African-Americans, with rates ranging from 13–51%.^[3]

The worldwide incidence and prevalence of trichomoniasis is reflected in the following table:^[4]

The prevalence of trichomonasis in the United States between 1966 and 2005 is reflected in the graph below:

Trichomoniasis and other vaginal infections in women — Initial visits to physicians’ offices: United States, 1966–2005:^[5][6]

The following demographic factors may affect incidence and prevalence of trichomoniasis:

Trichomoniasis occurs most commonly among women aged 20-45 years.^[7]

Females are more commonly affected by trichomoniasis than males.^[2]

Trichomoniasis usually affects African American individuals. Caucasian individuals are less likely to develop trichomoniasis. In the United States, the highest prevalence of trichomonas infection in women is observed among African-Americans, with rates ranging from 13–51%.^[3]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Common risk factors in the development of trichomoniasis include multiple sexual partners, unprotected sexual activity, intravenous drug use, and coexisting veneral disease.^[1][2]

Common risk factors in the development of trichomoniasis include:^[1][2]

• Multiple sexual partners
• Unprotected sexual activity
• Co-existing venereal diseases
• Intravenous drug use

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Routine screening is recommended for asymptomatic HIV-positive individuals and for all individuals identified as being at increased risk of infection.^[1][2]

Routine screening is recommended for the following individuals:^[1][2]

• HIV-positive (annually)
• Multiple sexual partners
• Unprotected sexual intercourse
• Illict drug use
• Previous history of STD
• Individuals receiving care in high-prevalence areas

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

If left untreated, women with trichomoniasis may progress to develop infection of the adnexa, endometrium, and Skene and Bartholin glands. In men, untreated trichomoniasis can cause epididymitis, prostatitis, and decreased sperm cell motility.^[1] Complications of trichomoniasis include pelvic inflammatory disease, increased risk of HIV, increased risk of cervical cancer, increased risk of prostate cancer, and pregnancy-related complications such as low birth weight, preterm delivery, and premature rupture of membranes. The prognosis of trichomoniasis is generally excellent with treatment.^[2]

If left untreated, women with trichomoniasis may progress to develop infection of the adnexa, endometrium, and Skene and Bartholin glands. In men, untreated trichomoniasis can cause epididymitis, prostatitis, and decreased sperm cell motility.^[1]

Common complications of trichomoniasis in women include:^[1]

• Pelvic inflammatory disease
• Pregnancy-related complications such as low birth weight, preterm delivery, and premature rupture of membranes
• Increased risk of acquiring HIV
• Increased risk of cervical neoplasia

Complications of trichomoniasis in men include:^[1]

• Epididymitis
• Prostatitis
• Increased risk of prostate cancer

The prognosis of trichomoniasis is generally excellent with treatment.^[2]

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