Trichomonas Vaginitis

Introduction

• Also k/a Trichomonas, Trichomoniasis or TV.
• It is caused by trichomonas vaginal which is a flagellated protozoan.
• It can infect the vagina, the urethra (the tube that carries urine out of the body) and under the foreskin of the penis.
• Very common sexually transmitted disease (STD). 
• Infection rates between men and women are similar with women usually being symptomatic, while infections in men are usually asymptomatic

History & Epidemiology

• Alfred Francois Donné (1801–1878) was the first to describe a procedure to diagnose trichomoniasis through “the microscopic observation of motile protozoa in vaginal or cervical secretions” in 1836.
• The WHO has estimated that 160 million cases of infection 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%.

Sign & Symptoms

• pH 5-6
• Profuse frothy greenish-yellow discharge.
• Urinary symptoms
• Dysuria
• Dyspareunia
• Sign: Strawberry vagina or angry-looking vagina due to capillary dilation as a result of the inflammatory response.

Men with trichomoniasis may notice:

• Itching or irritation inside the penis.
• Burning after urination or ejaculation.
• Discharge from the penis.

Investigations

• IOC– Saline microscopy– Typical motile flagellated trichomonas seen or some kind of motility seen trichomonas may be seen on a pap smear.
• Pap smear shows trichomonas, saline microscopy to further confirm the diagnose before initiating treatment.
• Gold standard investigation: Culture on- Feinberg’ Whittington media or Diamond media.
• Amine test/whiff test. i.e. 10% KOH added to discharge-May be positive/or negative due to its association with Bacterial vaginosis.

Diagnosis

• Examination of wet film at 35°C 
• Gram stain or Leishman stain is negative.
• Culture diagnosis
• Cytology
• PCR and NAAT(most sensitive)
• Antigen testing
• Pap smears a greyish blue pear-shaped structure without the flagella.
• A woman diagnosed with Trichomoniasis  should also be evaluated for Other venereal diseases 

Treatment

1. Non-pregnant females: Metronidazole (2 gm single-dose oral) or 500 mg BD x 7 days)
2. Treatment of male partner: Always done as Trichomonas vaginalis is an STD.
3. Pregnant females: Metronidazole (250 mg TDS x 7 days), During early pregnancy, vinegar douche to lower the pH, trichofuran suppositories and Betadine gel 
4. If this causes vomiting, or in resistant cases consider the use of alternative drugs tinidazole or secnidazole.

Complications:

• preterm delivery
• low birth weight
• increased mortality
• predisposing to HIV infection, AIDS, and cervical cancer. 
• T. vaginalis has also been reported in the urinary tract, fallopian tubes, and pelvis and can cause pneumonia, bronchitis, and oral lesions. 
• Males: asymptomatic urethritis and prostatitis.
• may increase the risk of prostate cancer.

Note: Condoms are effective at reducing, but not wholly preventing, transmission.

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