The most prevalent non-viral STI worldwide, trichomoniasis is thought to have caused 276.4 million new diagnoses in 2008 (WHO). While the frequency is greater in impoverished countries, diagnosis rates have consistently declined in industrialized nations. Trichomoniasis is identified in around 2% of GUM clinic visits in the UK.
Aetiology
The treatable sexually transmitted disease trichomoniasis is caused by the flagellated protozoan parasite Trichomonas vaginalis (TV).
Almost majority of adult television is received sexually. This is a site-specific infection for which the bacteria must be directly inoculated.
There may be female-to-female transmission.
Women’s infection locations include the urethra, periurethral glands, and vagina. Though it has also been identified in the subpreputial sac, in men the infection mostly affects the urethra.
TV increases the chance of contracting HIV and other STIs, such N. gonorrhoeae.
TV has a 20–25% spontaneous cure rate.
Symptoms and signs
Females
Some ten to fifty percent of women have no symptoms.
The symptoms include dysuria, vulval soreness/itching, and up to 70% of the time, excessive, unpleasant vaginal discharge.
In 10–15% of instances, symptoms may include vaginal discharge, vulvovaginitis, and strawberry cervix (small punctate cervical haemorrhages with ulceration).
Males
15% to 50% asymptomatic; they often show up as TV-owning partners of women.
Indications include dysuria, frequency, and urethral discharge.
Urethral discharge and, rarely, balanoposthitis are symptoms.
Diagnosis
Availability of tests, such near-patient microscopy, and the clinical setting will determine this.
Investigations in females
An easy point-of-care test that can be carried out in various clinical circumstances is vaginal pH testing. One sample is placed on narrow range pH paper from the lateral vaginal wall. Vaginal pH levels greater than 4.5 have been associated with TV.
Using quick microscopy on a specimen taken from the posterior vaginal fornix, identify motile trichomonads. The slide is ‘wet mount’ or suspended in saline. It will become less motile with time. This question is between forty and eighty percent sensitive.
When fast microscopy is not available, a high vaginal swab may be employed. It has to be sent to the lab in six hours.
Though not all laboratories provide it, TV-specific culture can diagnose up to 95% of cases. Tests for NAAT are not now widely used.
Investigations in males
Treatment is frequently based on epidemiology because males are hard to detect.
For quick microscopy, urine smears can be made in saline, although their sensitivity is only 30%.
A urethral or first void urine sample can be used for culture; it should be centrifuged within an hour. Both techniques taken together greatly raise diagnostic rates.
Liquid-based cervical cytology
One way to identify TV is as an unintentional finding in cervical biopsy samples.
Before commencing treatment, use culture or microscopy to confirm the diagnosis to prevent a high false positive rate (up to 30%).
Complications
Premature delivery, low birth weight, and preterm membrane rupture may all result from TV infection during pregnancy. Still, further study is required to show a clear connection.
Management of trichomoniasis
General
Suggest total abstinence, including condom use, till the course of treatment is over. Give in writing the details of the infection.
Offer to screen for different sexually transmitted diseases.
Talk about how barrier techniques should be applied consistently and precisely.
Treatment
Most T. vaginalis strains are well treated by nitroimidazole medications (95% cure rate). Typical regimens call for 400–500 mg twice day for 5-7 days, or 2 g of metronidazole taken orally in a single dose.
Aim to abstain from alcohol both during and after therapy to avoid a disulfiram-like reaction.
Treatment in pregnancy
Nothing suggests that metronidazole is teratogenic. Pregnant women should not use high-dose regimens, advises the BNF. High dose regimens should be avoided by nursing mothers since the medication can alter the flavor of their milk.
It is ok to take 400 mg of metronidazole every day for five to seven days while pregnant or nursing.
Partner notification Treating current partners should be done independent of the test findings.
Within four weeks after the encounter, treat it and provide partners with STI screening.
Follow-up/TOC
Assessing symptom remission, making sure medication is taken, avoiding sexual activity, and finishing PN all depend on follow-up after two weeks.
Should symptoms continue, a culture or microscopy cure test is advised. This is not necessary, though, if symptoms have gone away.
For guys with an excess of polymorphs on the first microscopy, repeat urethral microscopy is advised after two weeks to see if more treatment for non-gonococcal urethritis (NGU) is required.
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