Micrograph showing a positive result for trichomoniasis. A trichomonas organism is seen on the top-right of the image.
|Classification and external resources|
Trichomoniasis is a common cause of vaginitis. It is a sexually transmitted infection, 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. 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
Most people infected with trichomonas vaginalis do not have any symptoms. 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.
The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.
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.
There are three main ways to test for Trichomoniasis.
- The first is known as saline microscopy. 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, (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%).
- The third method includes the nucleic acid amplification tests (NAATs) which are more sensitive. These new NAATs include the Xpert TV (Cepheid, Sunnyvale, CA), APTIMA Trichomonas assay (Gen-Probe Inc, San Diego, CA) and the AFFIRM VPIII (BD Diagnostics, Sparks, MD). These tests are more costly than microscopy and culture, and are highly sensitive (80-90%).
Use of male condoms may help prevent the spread of trichomoniasis, 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.
Currently 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.
The advent of new, highly specific and sensitive trichomoniasis tests present 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 in the U.S., which can lead to better prevention efforts.
A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments.
Treatment for both pregnant and non-pregnant patients usually utilizes metronidazole (Flagyl), 2000 mg by mouth once. Caution should be used in pregnancy, especially in the first trimester. Sexual partners, even if asymptomatic, should also be treated.
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 7 days rather than with one dose.
Evidence from a 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. 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.
Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that:
- Trichomoniasis is associated with increased risk of transmission and infection of HIV.
- Trichomoniasis may cause a woman to deliver a low-birth-weight or premature infant.
- The role of trichomonas infection in causing cervical cancer is unclear, although 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, it may create chronic inflammation that may eventually lead to prostate cancer.
Trichomonas vaginalis infection is the most common non-viral STI in the world with an estimated 248 million new cases per year. It is more common in women (2.7%) than males (1.4%). 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. Recent studies have posited prevalence to be 3% of the general U.S. population, and 7.5-32% of moderate-to-high risk (including incarcerated) populations.
- 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.
- "STD Facts - Trichomoniasis". cdc.gov.
- Trichomoniasis symptoms. cdc.gov
- "Trichomoniasis - CDC Fact Sheet". Retrieved 12 January 2011.
- Scientists crack the genome of the parasite causing trichomoniasis. Physorg.com. Jan. 12, 2007.
- Fouts AC, Kraus SJ (1980). "Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis". J Infect Dis 141 (2): 137–143. doi:10.1093/infdis/141.2.137.
- Schwebke JR, Burgess D (2004). "Trichomoniasis". Clin Microbiol Rev. 17: 794–803.
- 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.
- Ginocchio C, Chapin K (2012). "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 50 (8): 2601–2608. doi:10.1128/JCM.00748-12.
- Vaginitis/Trichomoniasis :Reduce your risk, American Social Health Association. Retrieved March 12, 2008.
- Rob, Lukáš; Martan, Alois; Citterbart, Karel; et al. (2008). Gynekologie (in Czech) (2nd ed.). Prague: Galen. p. 136. ISBN 978-80-7262-501-7.
- Munson E (2014). "Point: new trichs for "old" dogs: prospects for expansion of Trichomonas vaginalis screening". Clin Chem. 60 (1): 151–4. doi:10.1373/clinchem.2013.210021.
- Wendel KA, Workowski KA (2007). "Trichomoniasis: challenges to appropriate management". Clin Infect Dis 44 (Suppl 3): S123–S129. doi:10.1086/511425.
- Workowski KA, Berman S. "Sexually transmitted diseases treatment guidelines, 2010" MMWR Recomm Rep 2010;59(RR-12):1–110.
- Smith L V, Sorvillo F, Kuo T (2013). "Implications of Trichomonas vaginalis nucleic acid amplification testing on medical training and practice". J Clin Microbiol 51 (5): 1650. doi:10.1128/JCM.00188-13.
- Desai, Monica; Woodhall, Sarah C; Nardone, Anthony; Burns, Fiona; Mercey, Danielle; Gilson, Richard (2015). "Active recall to increase HIV and STI testing: a systematic review". Sexually Transmitted Infections: sextrans–2014–051930. doi:10.1136/sextrans-2014-051930. ISSN 1368-4973: Access provided by the University of Pittsburgh Library System
- Vaginitis/Trichomoniasis :Treatment for trichomoniasis, American Social Health Association. Retrieved March 12, 2008.
- Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
- 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.
- Niccolai LM, Kopicko JJ, Kassie A, Petros H, Clark RA, Kissinger P (2000). "Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women". Sex Transm Dis. 27 (5): 284–288. doi:10.1097/00007435-200005000-00009.
- 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
- Secor W, Meites E, Starr M, Workowski K (2014). "Neglected parasitic infections in the United States: trichomoniasis". Am J Trop Med Hyg 90 (5): 800–804. doi:10.4269/ajtmh.13-0723.
- Kissinger, Patricia; Mena, Leandro; Levison, Judy; Clark, Rebecca A; Gatski, Megan; Henderson, Harold; Schmidt, Norine; Rosenthal, Susan L; Myers, Leann. "A Randomized Treatment Trial: Single Versus 7-Day Dose of Metronidazole for The Treatment of Trichomonas Vaginalis Among HIV-Infected Women". JAIDS Journal of Acquired Immune Deficiency Syndromes 55 (5): 565–571. doi:10.1097/qai.0b013e3181eda955.
- Klebanoff, Mark A.; Carey, J. Christopher; Hauth, John C.; Hillier, Sharon L.; Nugent, Robert P.; Thom, Elizabeth A.; Ernest, J.M.; Heine, R. Phillip; Wapner, Ronald J. (2001-08-16). "Failure of Metronidazole to Prevent Preterm Delivery among Pregnant Women with Asymptomatic Trichomonas vaginalis Infection". New England Journal of Medicine 345 (7): 487–493. doi:10.1056/NEJMoa003329. ISSN 0028-4793. PMID 11519502.
- McGregor, James A.; French, Janice I.; Parker, Ruth; Draper, Deborah; Patterson, Elisa; Jones, Ward; Thorsgard, Kyja; McFee, John. "Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation". American Journal of Obstetrics and Gynecology 173 (1): 157–167. doi:10.1016/0002-9378(95)90184-1.
- Kissinger P and Adamski A. "Trichomoniasis and HIV interactions: a review.". nih.gov.
- Donders GG; et al. (2013). "Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women.". nih.gov 8: e86266. doi:10.1371/journal.pone.0086266. PMC 3875579. PMID 24386492.
- Caini, Saverio; Gandini, Sara; Dudas, Maria; Bremer, Viviane; Severi, Ettore; Gherasim, Alin (2014). "Sexually transmitted infections and prostate cancer risk: A systematic review and meta-analysis". Cancer Epidemiology 38 (4): 329–338. doi:10.1016/j.canep.2014.06.002. ISSN 1877-7821. PMID 24986642.
- Stark, Jennifer R.; Judson, Gregory; Alderete, John F.; Mundodi, Vasanthakrishna; Kucknoor, Ashwini S.; Giovannucci, Edward L.; Platz, Elizabeth A.; Sutcliffe, Siobhan; et al. (2009). "Prospective Study of Trichomonas vaginalis Infection and Prostate Cancer Incidence and Mortality: Physicians' Health Study". JNCI Journal of the National Cancer Institute 101 (20): 1406–11. doi:10.1093/jnci/djp306. PMC 2765259. PMID 19741211.
- 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.
- World Health Organization, Department of Reproductive Health and Research. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Geneva, Switzerland; 2008.
- 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.
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, and TB. Division of STD Prevention. Trichomoniasis - CDC Fact Sheet. 2012.
- Satterwhite CL, Torrone E, Meites E; et al. (2013). "Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008". Sex Transm Dis. 40 (3): 187–93. doi:10.1097/OLQ.0b013e318286bb53.
- Sutton M, Sternberg M, Koumans EH, Mcquillan G, Berman S (2007). "The Prevalence of Trichomonas vaginalis Infection among Reproductive-Age Women in the United". Clin Infect Dis 45: 1319–1626. doi:10.1086/522532.
- Rogers SM, Turner CF, Hobbs M; et al. (2014). "Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults". PLOS ONE 9 (3): e90548. doi:10.1371/journal.pone.0090548.
- Javanbakht M, Stirland A, Stahlman S; et al. (2013). "Prevalence and Factors Associated With Trichomonas vaginalis Infection Among High-Risk Women in Los Angeles". Sex Transm Dis. 40 (10): 804–807. doi:10.1097/OLQ.0000000000000026.
- Helms DJ, Mosure DJ, Metcalf C; et al. (2008). "Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics". Sex Transm Dis. 35 (5): 484–8. doi:10.1097/OLQ.0b013e3181644b9c.
- Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES (2014). "Correlates of incident Trichomonas vaginalis infections among African American female adolescents". Sex Transm Dis. 41 (4): 240–5. doi:10.1097/OLQ.0000000000000094.
- Muzny C, Rivers C, Austin EL, Schwebke JR (2013). "Trichomonas vaginalis infection among women receiving gynaecological care at an Alabama HIV Clinic". Sex Transm Infect 89 (6): 514–8. doi:10.1136/sextrans-2012-050889.
- Munson E, Kramme T, Napierala M, Munson KL, Miller C, Hryciuk JE (2012). "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 50 (12): 3927–31. doi:10.1128/JCM.02078-12.
- 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
- Nijhawan AE, DeLong AK, Celentano DD; et al. (2011). "The Association Between Trichomonas Infection and Incarceration in HIV-Seropositive and At-Risk HIV-Seronegative Women". Sex Transm Dis. 38 (12): 1094–1100. doi:10.1097/OLQ.0b013e31822ea147.
- Trichomoniasis at Centers for Disease Control and Prevention
- Vaginitis/Vaginal infection fact sheet from the National Institute of Allergies and Infections. The first version of this article was taken from this public domain resource.
- eMedicine Health Trichomoniasis
- Trichomonas columbae video
- Can trichomoniasis be dormant?