Trichomoniasis

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Trichomoniasis
Trichomonas May-Grunwald staining.jpg
Micrograph showing Trichomonas vaginalis using May-Grünwald staining
Specialty Gynecology Microbiology Infectious diseases
Symptoms Itching in the genital area, bad smelling thin vaginal discharge, burning with urination, pain with sex [1] [2]
Usual onset5 to 28 days after exposure [1]
Causes Trichomonas vaginalis (typically sexually transmitted) [2] [1]
Diagnostic method Finding the parasite in vaginal fluid, microbial culture, testing for the parasites DNA [1]
PreventionNot having sex, using condoms, not douching [1]
Medication Antibiotics (metronidazole or tinidazole) [1]
Frequency122 million (2015) [3]

Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis . [2] About 70% of affected people do not have symptoms when infected. [2] When symptoms occur, they typically begin 5 to 28 days after exposure. [1] Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. [1] [2] Having trichomoniasis increases the risk of getting HIV/AIDS. [1] It may also cause complications during pregnancy. [1]

Contents

Trichomoniasis is a sexually transmitted infection (STI) which is most often spread through vaginal, oral, or anal sex. [1] It can also spread through genital touching (manual sex). [1] People who are infected may spread the disease even when symptoms are not present. [2] Diagnosis is by finding the parasite in the vaginal fluid using a microscope, culturing the vaginal fluid or urine, or testing for the parasite's DNA. [1] If present, other STIs should be tested for. [1]

Methods of prevention include not having sex, using condoms, not douching, and being tested for STIs before having sex with a new partner. [1] Although not caused by a bacterium, trichomoniasis can be cured with certain antibiotics (metronidazole, tinidazole, secnidazole). [1] Sexual partners should also be treated. [1] About 20% of people get infected again within three months of treatment. [2]

There were about 122 million new cases of trichomoniasis in 2015. [3] In the United States, there are about 2 million women affected. [1] It occurs more often in women than men. [1] Trichomonas vaginalis was first identified in 1836 by Alfred Donné. [4] It was first recognized as causing this disease in 1916. [5]

Signs and symptoms

A single trichomonas by phase contrast microscopy

Most people infected with Trichomonas vaginalis do not have any symptoms and can be undetected for years. [6] Symptoms experienced include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase during intercourse and urination. For women there may also be a yellow-green, itchy, frothy, foul-smelling ("fishy" smell) vaginal discharge. In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure. [7] Sometimes trichomoniasis can be confused with chlamydia because the symptoms are similar. [8]

Complications

Trichomoniasis is linked to several serious complications.

Causes

Lifecycle of Trichomonas Trichomoniasis 01.png
Lifecycle of Trichomonas

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact. [14]

The single-celled protozoan produces mechanical stress on host cells and then ingests cell fragments after cell death. [15]

Genetic sequence

A draft sequence of the Trichomonas 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. An additional approximately 34,000 unconfirmed genes, including thousands that are part of potentially transposable elements, brings the gene content to well over 60,000. [16]

Diagnosis

There are three main ways to test for trichomoniasis.

Prevention

Use of male condoms or female condoms may help prevent the spread of trichomoniasis, [22] although careful studies have never been done that focus on how to prevent this infection. Infection with trichomoniasis through water is unlikely because Trichomonas vaginalis dies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in diluted urine after 5–6 hours. [23]

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing. [24] [25] The Centers for Disease Control and Prevention (CDC) recommends trichomoniasis testing for females with vaginal discharge [26] and can be considered for females at higher risk for infection or of HIV-positive serostatus. [24]

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women. [24] [27] Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis in the U.S., which can lead to better prevention efforts. [24] [27]

A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments. [28]

Screening

Evidence from randomized controlled trials for screening pregnant women who do not have symptoms for infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of preterm birth. [29] [30] Further studies are needed to verify this result and determine the best method of screening. In the US, screening of pregnant women without any symptoms is only recommended in those with HIV as Trichomonas infection is associated with increased risk of transmitting HIV to the fetus. [31]

Treatment

Treatment for both pregnant and non-pregnant women is usually with metronidazole, [32] by mouth once. [31] Caution should be used in pregnancy, especially in the first trimester. [33] Sexual partners, even if they have no symptoms, should also be treated. [23] Single oral dose of nitroimidazole is sufficient to kill the parasites. [34]

For 95–97% of cases, infection is resolved after one dose of metronidazole. [26] [35] Studies suggest that 4–5% of trichomonas cases are resistant to metronidazole, which may account for some "repeat" cases. [33] [9] Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men. [9] Women living with HIV infection have better cure rates if treated for seven days rather than with one dose. [31] [36]

Topical treatments are less effective than oral antibiotics due to Skene's gland and other genitourinary structures acting as a reservoir. [37]

Epidemiology

There were about 58 million cases of trichomoniasis in 2013. [38] It is more common in females (2.7%) than males (1.4%). [39] It is the most common non-viral STI in the U.S., with an estimated 3.7 million prevalent cases and 1.1 million new cases per year. [40] [41] It is estimated that 3% of the general U.S. population is infected, [21] [42] and 7.5–32% of moderate-to-high risk (including incarcerated) populations. [43] [44]

See also

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<span class="mw-page-title-main">Chlamydia</span> Sexually transmitted infection caused by the bacterium Chlamydia trachomatis

Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Most people who are infected have no symptoms. When symptoms do appear they may occur only several weeks after infection; the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. Symptoms in women may include vaginal discharge or burning with urination. Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Cervicitis</span> Inflammation of the uterine cervix

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.

<span class="mw-page-title-main">Chancroid</span> Sexually transmitted bacterial infection in humans

Chancroid is a bacterial sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to spread from one individual to another solely through sexual contact. However, there have been reports of accidental infection through the hand.

<i>Trichomonas vaginalis</i> Species of parasite that causes sexually transmitted infections

Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of a sexually transmitted disease called trichomoniasis. It is the most common pathogenic protozoan that infects humans in industrialized countries. Infection rates in men and women are similar but women are usually symptomatic, while infections in men are usually asymptomatic. Transmission usually occurs via direct, skin-to-skin contact with an infected individual, most often through vaginal intercourse. 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%. Usually treatment consists of metronidazole and tinidazole.

<i>Trichomonas</i> Genus of parasitic, flagellated protists

Trichomonas is a genus of anaerobic excavate parasites of vertebrates. It was first discovered by Alfred François Donné in 1836 when he found these parasites in the pus of a patient suffering from vaginitis, an inflammation of the vagina. Donné named the genus from its morphological characteristics. The prefix tricho- originates from the Ancient Greek word θρίξ (thrix) meaning hair, describing Trichomonas’s flagella. The suffix -monas, describes its similarity to unicellular organisms from the genus Monas.

Leukorrhea or, also known as fluor albus, is a thick, whitish, yellowish or greenish vaginal discharge. It has also been referred to as "the whites". There are many causes of leukorrhea, the usual one being estrogen imbalance. The amount of discharge may increase due to vaginal infection, and it may disappear and reappear from time to time. This discharge can keep occurring for years, in which case it becomes more yellow and strong-smelling. It is usually a non-pathological symptom secondary to inflammatory conditions of the vagina or cervix.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Genital herpes</span> Infection by herpes simplex viruses of the genitals

Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder.

Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether they identify themselves as lesbian, bisexual, or heterosexual, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.

<span class="mw-page-title-main">Protozoan infection</span> Parasitic disease caused by a protozoan

Protozoan infections are parasitic diseases caused by organisms formerly classified in the kingdom Protozoa. These organisms are now classified in the supergroups Excavata, Amoebozoa, Harosa, and Archaeplastida. They are usually contracted by either an insect vector or by contact with an infected substance or surface.

<span class="mw-page-title-main">Gonorrhea</span> Sexually transmitted infection

Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

<span class="mw-page-title-main">Vaginal yeast infection</span> Medical condition

Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burning with urination, a thick, white vaginal discharge that typically does not smell bad, pain during sex, and redness around the vagina. Symptoms often worsen just before a woman's period.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

References

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