Trichomonas vaginalis

Question 1

What causes trichomonas vaginalis

Answer 1

Flagellated protozoan Trichomonas vaginalis

Transmission: sexual intercourse, vertical from mother to baby

Question 2

What are the symptoms of trichomonas vaginalis in women

Answer 2

50% asymptomatic

Vaginal discharge (Yellow-green and frothy, Thin and scanty OR profuse and thick)
Vulval itching
Dysuria
Offensive odour
Vulval soreness or ulceration
Lower abdominal pain

Question 3

What are the symptoms and signs of Trichomonas vaginalis in men

Answer 3

Urethral discharge (Usually a small amount)
Dysuria
Increased urinary frequency
Urethral irritation

Testicular/penile exam: Urethral discharge, signs of balanitis/balanoposthitis (inflammation of the glans penis and prepuce)

Question 4

What are the signs of trichomonas vaginalis in women

Answer 4

Abdominal exam
- Tenderness
- Mass

Vulva
- Lesions
- Discharge
- Vulvitis
- Ulcers

Speculum
- Yellow-green, frothy discharge with fish odour
- Inflammation of vulva and vagina
- Cervicitis → strawberry cervix (erythematous, punctate, and papilliform)
- May be normal

Question 5

What investigations should be done for trichomonas vaginalis

Answer 5

Refer to GUM clinic

Bedside:
- pH testing: >4.5
- high vaginal swab for direct microscopy: +ve for TV
- Urethral swab/first catch urine for MC&S: +ve for TV

Bloods: HIV serology, syphilis serology, hepatitis serology

Question 6

What is the management for trichomonas vaginalis

Answer 6

1. Refer to GUM clinic
2. Antibiotics: oral metronidazole 2x a day for 5-7 days OR single dose
3. Screen for other STIs
4. Partner (4 weeks) notification AND treatment
5. Abstain for sex for at least 1 week and until treatment is complete in both patient and partner

+ follow up

Question 7

What are the complications of trichomonas vaginalis

Answer 7

Perinatal: preterm delivery, LBW, maternal postpartum sepsis
Facilitation of HIV transmission
Pelvic inflammatory disease
Alterations to normal vaginal flora → increased susceptibility to VBV
Increased risk of cervical cancer (Especially if HPV co-infected)
Infertility

Men: prostatitis, prostate cancer, infertility

Question 8

What is the prognosis for trichomonas vaginalis

Answer 8

Overall, with the proper treatment, the prognosis is very good for all types of vaginitis.