Trichomoniasis

 


Trichomoniasis




GENERAL CONSIDERATIONS


Trichomoniasis (trich) is a common disease affecting one in five women in the United States during their lifetime. Five million cases appear each year. It is present in 3%-15% of asymptomatic women treated at obstetric/gynecologic clinics and 20%-50% of women treated at sexually transmitted disease clinics.




• Gonorrhea (GC) and trich commonly coexist; 40% of women with trich have GC and vice versa.


• Trich frequently causes cervical erosion (90%), a factor in malignancy.


• Trich may complicate interpretation of Pap smears, increasing number of false-positive results.


• Trich increases sterility in women (salpingitis) and men (toxins decrease motility of spermatozoa).


• Increased postpartum fever and discharge in women with Trichomonas vaginalis at delivery.


• Neonates infected from passage through the birth canal may manifest serious illness (rare).


• Prostatitis and epididymitis are common in infected men.


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• Infection may confuse and/or complicate other genitourinary tract problems.


• Metronidazole (Flagyl) (most common anti-trich agent) is carcinogenic and teratogenic in rodents.


• Trich increases HIV transmission and infectivity where HIV seropositive men with concomitant trichomoniasis may have sixfold higher concentration of HIV RNA in seminal plasma.



DIAGNOSIS


Trichomonas vaginalis is a flagellate 15-18 mm long, shaped like a turnip, with three to four anterior and one posterior flagella mounted in undulating membrane. Transmission is through sexual intercourse; men and women are reservoirs. Diagnosis is by signs and symptoms (above), saline wet mount, and culture. Trich cultures (Feinberg Trichomonas medium) increase diagnostic sensitivity. Fifty percent of women with Trichomonas (defined by positive culture) have the organism identified by microscopic wet mount. Although microscopic wet mount is commonly used and a quick method to identify trich compared with culture, sensitivity of wet mount ranges from only 45%-60%. In men a reliable culture site has not been established, and cultures from urine and seminal samples give low yield. The organism can be cultured from vagina and paraurethral glands in 98%, the urethra in 82%, and endocervix in 13%. In only 56%-65% is T. vaginalis seen on Pap smear; thus Pap smear is an unreliable form of diagnosis. DNA-based test called Affirm VP system uses synthetic oligonucleotide probes for detection of T. vaginalis, Gardnerella vaginalis, and Candida spp. from a single vaginal swab, with sensitivity of 92% and specificity of 98% compared with wet mount and sensitivity of 92% and specificity of 99% compared with culture. Newer diagnostics such as polymerase chain reaction (PCR) can increase identification in men and women. Unfortunately, PCR is restricted to research settings because of technical complexity and cost.



Trichomonal Vaginitis




• Sexual transmission is the route of infection. Prevalence is highest among women with multiple partners and women with other sexually transmitted infections. Transmission rates are high from men to women; an 80%-100% prevalence exists in female partners of infected men.


• In women, T. vaginalis infests the vagina and urethra and may involve the endocervix, Bartholin’s glands, Skene’s glands, and bladder.


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Apr 3, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Trichomoniasis

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