Trichomoniasis overview
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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]
Overview
Trichomoniasis is a common sexually transmitted disease that affects 7.4 million previously unaffected Americans each year. It is caused by a single-celled protozoan parasite Trichomonas vaginalis. Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.[1] 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. It is most common in women and uncircumcised men. For uncircumcised men, the most common site for the infection is the tip of the penis.
Historical Perspective
Trichomonas vaginalis was first discovered by Dr. Alfred François Donné, a French physician, in 1836.[1]
Pathophysiology
Causes
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.
Differential Diagnosis
Trichomoniasis must be differentiated from other causes of vaginitis such as bacterial vaginosis, vulvovaginal candidiasis, and atrophic vaginitis.[2]
Epidemiology and Demographics
Trichomoniasis is the most common curable STD in young, sexually active women. An estimated 7.4 million new cases occur each year in women and men. In 2008, the incidence of trichomoniasis was estimated to be 358 cases per 100,000 individuals in the United States.[3] Females are more commonly affected with trichomoniasis than males.[4] 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 US women is seen among African-Americans with rates ranging from 13–51%.[5]
Risk Factors
The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.[6] Hence higher prevalence is among persons with multiple sexual partners or other venereal diseases.
Natural History, Complications, and Prognosis
If left untreated, women with trichomoniasis may progress to develop infection of the adnexa, endometrium, and Skene and Bartholin glands. In men, it can cause epididymitis, prostatitis, and decreased sperm cell motility.[5] 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.[7]
Diagnosis
History and Symptoms
A detailed and thorough sexual history from the patient is necessary. 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.[5] Symptoms of trichomoniasis in males include clear or mucopurulent urethral discharge, painful urination, and pruritus or a burning sensation following sexual intercourse.[8]
Physical Examination
For both men and women, a health care provider must perform a physical examination and laboratory test to diagnose trichomoniasis. The parasite is harder to detect in men than in women. In women, a pelvic examination can reveal small red ulcerations (sores) on the vaginal wall or cervix.
Laboratory Findings
Diagnosis of vaginal trichomoniasis is usually performed by microscopy of vaginal secretions, but this method has a sensitivity of only approximately 60%-70% and requires immediate evaluation of wet preparation slide for optimal results.
Other Diagnostic Studies
Treatment
Medical Therapy
Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth 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 trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
References
- ↑ 1.0 1.1 Thorburn AL (1974). "Alfred François Donné, 1801-1878, discoverer of Trichomonas vaginalis and of leukaemia". Br J Vener Dis. 50 (5): 377–80. PMC 1045069. PMID 4138951.
- ↑ Hainer BL, Gibson MV (2011). "Vaginitis". Am Fam Physician. 83 (7): 807–15. PMID 21524046.
- ↑ Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States. CDC.http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf Accessed on February 2, 2016
- ↑ Trichomoniasis Statistics. CDC.http://www.cdc.gov/std/trichomonas/stats.htm Accessed on January 26, 2016
- ↑ 5.0 5.1 5.2 Kissinger P (2015). "Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues". BMC Infect Dis. 15: 307. doi:10.1186/s12879-015-1055-0. PMC 4525749. PMID 26242185.
- ↑ "Trichomoniasis - CDC Fact Sheet". Retrieved 12 January 2011.
- ↑ Swygard H, Seña AC, Hobbs MM, Cohen MS (2004). "Trichomoniasis: clinical manifestations, diagnosis and management". Sex Transm Infect. 80 (2): 91–5. PMC 1744792. PMID 15054166.
- ↑ "Trichomoniasis - CDC Fact Sheet". Retrieved 12 January 2011.