Trichomoniasis

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"Trich" redirects here. For the hair-pulling disorder, see Trichotillomania.
Not to be confused with Trichinosis or Trichuriasis.
Trichomoniasis
Classification and external resources
Trichomonas pap test.jpg
Micrograph showing a positive result for trichomoniasis. A trichomonas organism is seen on the top-right of the image.
ICD-10 A59
ICD-9 131,007.3
DiseasesDB 13334
MedlinePlus 001331
eMedicine med/2308 emerg/613
MeSH D014246

Trichomoniasis, is a common cause of vaginitis. It is a sexually transmitted disease, and is caused by the single-celled protozoan parasite Trichomonas vaginalis producing mechanical stress on host cells and then ingesting cell fragments after cell death.[1] Trichomoniasis is primarily an infection of the urogenital tract; the most common site of infection is the urethra and the vagina in women.

Signs and symptoms[edit]

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.[2] In many cases, men may hold the parasite for some years without any signs.

Diagnosis[edit]

There are three main ways to test for Trichomoniasis: (1) Saline microscopy. This is the method most commonly used. It 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 it has a low sensitivity (60-70%) often due to an inadequate sample, resulting in false negatives.[3][4] (2) Culture, (InPouch TV culture test, BioMed Diagnostics, San Jose, CA) which has historically been the “gold standard” in infectious disease diagnosis. Trichomonas Vaginalis culture tests are relatively cheap however sensitivity is still somewhat low (70-89%)[5] (3) New, more sensitive tests including the nucleic acid amplification tests (NAATs). These new NAATs include the APTIMA Trichomonas assay (Gen-Probe Inc, San Diego, CA) and the AFFIRM VPIII (BD Diagnostics, Sparks, MD).[5] These tests are more costly than microscopy and culture, and are highly sensitive (80-90%).[6]

Causes[edit]

Lifecycle of Trichomonas

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.[7]

Genetic sequence[edit]

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 ~35,000 unconfirmed genes, including thousands that are part of potential transposable elements, brings the gene content to well over 60,000.[8]

Prevention[edit]

Use of male condoms may help prevent the spread of trichomoniasis,[9] 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.[10]

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing.[11][12] The Centers for Disease Control and Prevention (CDC) recommends Trichomoniasis testing for females with vaginal discharge[13] and can be considered for females at higher risk for infection or of HIV-positive serostatus.[11]

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women.[11][14] 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.[11][14]

Treatment[edit]

Treatment for both pregnant and non-pregnant patients usually utilizes metronidazole (Flagyl),[15] but with caution especially in early stages of pregnancy[16] 2000 mg by mouth once. Sexual partners, even if asymptomatic, should be treated concurrently.[10]

For 95-97% of cases, infection is resolved after one dose of metronidazole.[13][17] Studies suggest that 4-5% of TV cases are resistant to metronidazole, which may account for some “repeat” cases.[18][19] Without treatment, trichomoniasis can persist for months to years in women, and is thought to typically “resolve itself” in men.[19]

Complications[edit]

Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that:

  • Trichomoniasis is associated with increased risk of transmission of HIV.[19]
  • Trichomoniasis may cause a woman to deliver a low-birth-weight or premature infant.[19]
  • Trichomoniasis is also associated with increased chances of cervical cancer
  • Evidence implies that infection in males potentially raises the risks of prostate cancer development and spread due to inflammation.[20][21]

Additional research is needed to fully explore these relationships.

Epidemiology[edit]

Trichomonas vaginalis infection is the most common non-viral STI in the world with an estimated 248 million new cases per year.[22][23] It is more common in women (2.7%) than males (1.4%).[24] It is also 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.[25][26] Recent studies have posited prevalence to be 3% of the general U.S. population,[6][27] and 7.5-32% of moderate-to-high risk (including incarcerated) populations.[28][29][30][31][32][33][34][35]

References[edit]

  1. ^ Midlej V., Benchimol M. (2010). "Trichomonas vaginalis kills and eats- evidence for phagocytic activity as a cytopathic effect". Parasitology 137 (1): 65–76. doi:10.1017/S0031182009991041. PMID 19723359. 
  2. ^ Trichomoniasis symptoms. cdc.gov
  3. ^ Fouts AC, Kraus SJ. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980;141(2):137–143.
  4. ^ Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004;17:794–803.
  5. ^ a b Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2008;200(2):188e1–188e2.
  6. ^ a b Ginocchio C, Chapin K. Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol. 2012;50(8):2601. doi:10.1128/JCM.00748-12.
  7. ^ "Trichomoniasis - CDC Fact Sheet". Retrieved 12 January 2011. 
  8. ^ Scientists crack the genome of the parasite causing trichomoniasis. Physorg.com. Jan. 12, 2007.
  9. ^ Vaginitis/Trichomoniasis :Reduce your risk, American Social Health Association. Retrieved March 12, 2008.
  10. ^ a b Rob, Lukáš; Martan, Alois; Citterbart, Karel et al. (2008). Gynekologie (in Czech) (2nd ed.). Prague: Galen. p. 136. ISBN 978-80-7262-501-7. 
  11. ^ a b c d Munson E. Point: new trichs for “old” dogs: prospects for expansion of Trichomonas vaginalis screening. Clin Chem. 2014;60(1):151–4. doi:10.1373/clinchem.2013.210021.
  12. ^ Wendel KA, Workowski KA. Trichomoniasis: challenges to appropriate management. Clin Infect Dis. 2007;44 Suppl 3:S123–S129. doi:10.1086/511425.
  13. ^ a b Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110.
  14. ^ a b Smith L V, Sorvillo F, Kuo T. Implications of Trichomonas vaginalis nucleic acid amplification testing on medical training and practice. J Clin Microbiol. 2013;51(5):1650. doi:10.1128/JCM.00188-13.
  15. ^ Vaginitis/Trichomoniasis :Treatment for trichomoniasis, American Social Health Association. Retrieved March 12, 2008.
  16. ^ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE (October 2004). "Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis". Clin. Microbiol. Rev. 17 (4): 783–93, table of contents. doi:10.1128/CMR.17.4.783-793.2004. PMC 523556. PMID 15489348. 
  17. ^ Niccolai LM, Kopicko JJ, Kassie A, Petros H, Clark RA, Kissinger P. Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women. Sex Transm Dis. 2000;27(5):284–288. doi:10.1097/00007435-200005000-00009.
  18. ^ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE. Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis. Clin Microbiol Rev. 2004;17(4):783–93, table of contents. doi:10.1128/CMR.17.4.783-793.2004.
  19. ^ a b c d Secor W, Meites E, Starr M, Workowski K. Neglected parasitic infections in the United States: trichomoniasis. Am J Trop Med Hyg. 2014;90(5):800–804. doi:10.4269/ajtmh.13-0723.
  20. ^ Jennifer R. Stark et al (2009). Prospective Study of Trichomonas vaginalis Infection and Prostate Cancer Incidence and Mortality: Physicians' Health Study, Retrieved May 20, 2014.
  21. ^ BBC (2014). Prostate cancer 'may be a sexually transmitted disease', Retrieved May 20, 2014.
  22. ^ World Health Organization. Prevalence and Incidence of Selected Sexually Transmitted Infections, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis and Trichomonas vaginalis: Methods and Results Used by WHO to Generate 2005 Estimates. 2011. Available at: http://whqlibdoc.who.int/publications/ 2011/9789241502450_eng.pdf.
  23. ^ World Health Organization, Department of Reproductive Health and Research. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Geneva, Switzerland; 2008.
  24. ^ Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607. 
  25. ^ Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, and TB. Division of STD Prevention. Trichomoniasis - CDC Fact Sheet. 2012.
  26. ^ Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–93. doi:10.1097/OLQ.0b013e318286bb53.
  27. ^ Sutton M, Sternberg M, Koumans EH, Mcquillan G, Berman S. The Prevalence of Trichomonas vaginalis Infection among Reproductive-Age Women in the United. Clin Infect Dis. 2007;45:1319–1626. doi:10.1086/522532.
  28. ^ Rogers SM, Turner CF, Hobbs M, et al. Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults. PLoS One. 2014;9(3):e90548. doi:10.1371/journal.pone.0090548.
  29. ^ Javanbakht M, Stirland A, Stahlman S, et al. Prevalence and Factors Associated With Trichomonas vaginalis Infection Among High-Risk Women in Los Angeles. Sex Transm Dis. 2013;40(10):804–807. doi:10.1097/OLQ.0000000000000026.
  30. ^ Helms DJ, Mosure DJ, Metcalf C, et al. Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics. Sex Transm Dis. 2008;35(5):484–8. doi:10.1097/OLQ.0b013e3181644b9c.
  31. ^ Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES. Correlates of incident Trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis. 2014;41(4):240–5. doi:10.1097/OLQ.0000000000000094.
  32. ^ Muzny C, Rivers C, Austin EL, Schwebke JR. Trichomonas vaginalis infection among women receiving gynaecological care at an Alabama HIV Clinic. Sex Transm Infect. 2013;89(6):514–8. doi:10.1136/sextrans-2012-050889.
  33. ^ Munson E, Kramme T, Napierala M, Munson KL, Miller C, Hryciuk JE. Female epidemiology of transcription-mediated amplification-based Trichomonas vaginalis detection in a metropolitan setting with a high prevalence of sexually transmitted infection. J Clin Microbiol. 2012;50(12):3927–31. doi:10.1128/JCM.02078-12.
  34. ^ Freeman AH, Katz KA, Pandori MW, et al. Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay. Sex Transm Dis. 2010;37(3):165–168. doi:10.1097/OLQ.0b013e3181bcd3fc.
  35. ^ Nijhawan AE, DeLong AK, Celentano DD, et al. The Association Between Trichomonas Infection and Incarceration in HIV-Seropositive and At-Risk HIV-Seronegative Women. Sex Transm Dis. 2011;38(12):1094–1100. doi:10.1097/OLQ.0b013e31822ea147.

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