Trichomoniasis
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Trichomoniasis (trich) is an infectious disease caused by the parasite ''
Trichomonas vaginalis ''Trichomonas vaginalis'' is an Anaerobic organism, anaerobic, flagellated protozoan parasite and the causative agent of a Sexually transmitted infection, sexually transmitted disease called trichomoniasis. It is the most common pathogenic protoz ...
''. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting
HIV/AIDS The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
. It may also cause complications during
pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...
. Trichomoniasis is a
sexually transmitted infection 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 Transmission (medicine), spread by Human sexual activity, sexual activity, e ...
(STI) most often spread by vaginal, oral, or anal sex. It can also spread through genital touching (manual sex). Infected people may spread the disease even when symptoms are absent. Diagnosis is by finding the parasite in the
vaginal fluid 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, ...
using a
microscope A microscope () is a laboratory equipment, laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic ...
, culturing the vaginal fluid or urine, or testing for the parasite's
DNA Deoxyribonucleic acid (; DNA) is a polymer composed of two polynucleotide chains that coil around each other to form a double helix. The polymer carries genetic instructions for the development, functioning, growth and reproduction of al ...
. If present, other STIs should be tested for. Methods of prevention include not having sex, using
condoms A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both external condoms, also called male condoms, and internal (female) ...
, not douching, and being tested for STIs before having sex with a new partner. Although not caused by a bacterium, trichomoniasis can be cured with certain
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
s (
metronidazole Metronidazole, sold under the brand name Flagyl and Metrogyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vagino ...
, tinidazole,
secnidazole Secnidazole (trade names Flagentyl, Sindose, Secnil, Solosec) is a nitroimidazole anti-infective used to treat bacterial vaginosis and trichomoniasis. It is taken orally. Structurally it actually methyl-metronidazole. Effectiveness in the tr ...
). Sexual partners should also be treated. About 20% of people get infected again within three months of treatment. There were about 122 million new cases of trichomoniasis in 2015. In the United States, about 2 million women are affected. It occurs more often in women than men. ''Trichomonas vaginalis'' was first identified in 1836 by Alfred Donné. It was first recognized as causing this disease in 1916.


Signs and symptoms

Most people infected with ''Trichomonas vaginalis'' do not have any symptoms and it can be undetected for years. Symptoms include pain, burning or itching in the penis, urethra ( urethritis), or vagina (
vaginitis 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. The three mai ...
). Discomfort for both sexes may increase during intercourse and
urination Urination is the release of urine from the bladder through the urethra in Placentalia, placental mammals, or through the cloaca in other vertebrates. It is the urinary system's form of excretion. It is also known medically as micturition, v ...
. 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.Trichomoniasis symptoms
. cdc.gov
Sometimes trichomoniasis can be confused with
chlamydia 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 w ...
because the symptoms are similar.


Complications

Trichomoniasis is linked to several serious complications. * Trichomoniasis is associated with an increased risk of transmission and infection of HIV. * Trichomoniasis may cause a woman to deliver a low-birth-weight or
premature Premature may refer to: * ''Premature'' (2014 film), an American comedy film * ''Premature'' (2019 film), an American romantic drama film * '' PREMature'', a 2015 British television drama miniseries See also * Premature aging, of an organism * ...
infant. * The role of ''Trichomonas'' infection in causing
cervical cancer Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later sympt ...
is unclear. However, trichomonas infection may be associated with co-infection with high-risk strains of HPV. * ''T. vaginalis'' infection in males has been found to cause asymptomatic urethritis and prostatitis. In the
prostate The prostate is an male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemica ...
, it may create chronic inflammation that may eventually lead to
prostate cancer Prostate cancer is the neoplasm, uncontrolled growth of cells in the prostate, a gland in the male reproductive system below the bladder. Abnormal growth of the prostate tissue is usually detected through Screening (medicine), screening tests, ...
.


Causes

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact. The single-celled
protozoan Protozoa (: protozoan or protozoon; alternative plural: protozoans) are a polyphyletic group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic debris. Historically ...
produces mechanical stress on host cells and then ingests cell fragments after cell death.


Genetic sequence

A draft sequence of the ''Trichomonas''
genome A genome is all the genetic information of an organism. It consists of nucleotide sequences of DNA (or RNA in RNA viruses). The nuclear genome includes protein-coding genes and non-coding genes, other functional regions of the genome such as ...
was published on January 12, 2007, in the journal ''
Science Science is a systematic discipline that builds and organises knowledge in the form of testable hypotheses and predictions about the universe. Modern science is typically divided into twoor threemajor branches: the natural sciences, which stu ...
'', confirming that the genome has at least 26,000 genes, a similar number to the
human genome The human genome is a complete set of nucleic acid sequences for humans, encoded as the DNA within each of the 23 distinct chromosomes in the cell nucleus. A small DNA molecule is found within individual Mitochondrial DNA, mitochondria. These ar ...
. 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.


Diagnosis

There are three main ways to test for trichomoniasis. * The first is known as saline
microscopy Microscopy is the technical field of using microscopes to view subjects too small to be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of microscopy: optical mic ...
. This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope. The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60–70%) often due to an inadequate sample, resulting in false negatives. * The second diagnostic method is
culture Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...
, which has historically been the "gold standard" in infectious disease diagnosis. ''Trichomonas vaginalis'' culture tests are relatively cheap but their sensitivity is still somewhat low (70–89%). * The third method includes the nucleic acid amplification tests (NAATs), which are more sensitive. These tests are more costly than microscopy and culture, and are highly sensitive (80–90%).


Prevention

Use of male
condom A condom is a sheath-shaped Barrier contraception, barrier device used during sexual intercourse to reduce the probability of pregnancy or a Sexually transmitted disease, sexually transmitted infection (STI). There are both external condo ...
s or female condoms may help prevent the spread of trichomoniasis, although careful studies have never been done 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. There are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing. The Centers for Disease Control and Prevention (CDC) recommends trichomoniasis testing for females with vaginal discharge and can be considered for females at higher risk for infection or of HIV-positive
serostatus Serostatus refers to the presence or absence of a serological Serology is the scientific study of serum and other body fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum. Such antibodies are t ...
. The advent of new, highly specific, and sensitive trichomoniasis tests presents opportunities for new screening protocols for both men and women. 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, which can lead to better prevention efforts. Several strategies have been found to improve follow-up for STI testing, including email and text messaging as reminders of appointments.


Screening

Evidence from randomized controlled trials for screening pregnant women who have no symptoms of infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of
preterm birth Preterm birth, also known as premature birth, is the Childbirth, birth of a baby at fewer than 37 weeks Gestational age (obstetrics), gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 ...
. Further studies are needed to verify this result and determine the best method of screening. In the U.S., screening of pregnant women without symptoms is recommended only for those with HIV, as ''Trichomonas'' infection is associated with an increased risk of transmitting HIV to the fetus.


Treatment

Treatment for both pregnant and non-pregnant women is usually with
metronidazole Metronidazole, sold under the brand name Flagyl and Metrogyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vagino ...
, by mouth once. Caution should be used in pregnancy, especially in the first trimester. Sexual partners, even if they have no symptoms, should also be treated. Single oral dose of
nitroimidazole Nitroimidazoles are the group of organic compound, organic compounds consisting of an imidazole ring with at least one nitro group substituent. The term also refers to the class of antibiotics that have nitroimidazole in their structures. These an ...
is sufficient to kill the parasites. For 95–97% of cases, infection is resolved after one dose of metronidazole. Studies suggest that 4–5% of trichomonas cases are resistant to metronidazole, which may account for some "repeat" cases. Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men. Women living with HIV infection have better cure rates if treated for seven days rather than with one dose. Topical treatments are less effective than oral antibiotics due to Skene's gland and other genitourinary structures acting as reservoirs. Vaginal
boric acid Boric acid, more specifically orthoboric acid, is a compound of boron, oxygen, and hydrogen with formula . It may also be called hydrogen orthoborate, trihydroxidoboron or boracic acid. It is usually encountered as colorless crystals or a white ...
can be useful against resistant trichomoniasis.


Epidemiology

There were about 58 million cases of trichomoniasis in 2013. It is more common in females (2.7%) than males (1.4%). 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. It is estimated that 3% of the general U.S. population is infected, and 7.5–32% of moderate-to-high risk (including incarcerated) populations.


See also

* Trichomonas gallinae is a related pathogen of birds


References


External links


Trichomoniasis at Centers for Disease Control and Prevention


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