Trichomonas vaginalis

Question 1

What type of organism is trichomonas vaginalis?

Answer 1

Flagellated protozoon

Question 2

Where in women is T vaginalis infection found?

Answer 2

Vagina
Urethra
Paraurethral glands

Question 3

Where in men is T vaginalis infection found?

Answer 3

Urethra
Subpreputial sac
Lesions of the penis

Question 4

What are the symptoms of T vaginalis infection in women? (7)

Answer 4

Asymptomatic
Vaginal discharge
Vulval itching
Dysuria
Offensive odour
Lower abdominal pain
Vulval ulceration

Question 5

How often is T vaginalis asymptomatic in women?

Answer 5

10-50%

Question 6

What are the symptoms of T vaginalis infection in men? (4)

Answer 6

Urethral discharge
Dysuria
Urethral irritation
Urinary frequency

Question 7

What is the most common presentation of T vaginalis in men?

Answer 7

Urethral discharge

Dysuria

Question 8

What is the classic description of vaginal discharge in T vaginalis infection?

Answer 8

Frothy yellow discharge

Question 9

How common is frothy yellow discharge in T vaginalis infection?

Answer 9

10-30%

Question 10

What is the pathognomonic appearance of the cervix in T vaginalis infection? How common is it?

Answer 10

Strawberry cervix

2%

Question 11

How often is vaginal discharge the presenting complaint in T vaginalis infection?

Answer 11

70%

Question 12

How often will a man be asymptomatic of T vaginalis infection?

Answer 12

77%

Question 13

What impact may T vaginalis infection have on a pregnancy?

Answer 13

Preterm delivery

Low birth weight

Question 14

What impact may T vaginalis infection have on a woman postpartum?

Answer 14

Predispose to maternal postpartum SEPSIS

Question 15

When should women have testing for T vaginalis?

Answer 15

Vaginal discharge
Vulvitis
Evidence of vulvitis or vaginitis on examination

Question 16

When should men have testing for T vaginalis?

Answer 16

TV contacts

Persistent urethritis

Question 17

What is the preferred specimen for T vaginalis in women?

Answer 17

Swab of posterior fornix during speculum

Question 18

What specimen is required for T vaginalis in men?

Answer 18

Urethral swab OR

first void urine

Question 19

How sensitive is testing for T vaginalis in men?

Answer 19

60-80% with urethral or FVU culture

Sampling both sites significantly increases diagnostic rate

Question 20

Microscopy - T vaginalis - describe the steps?

Answer 20

Wet preparation slide - vaginal discharge
Low magnification 100x - scan slide
Higher magnification 400x - confirm morphology of trichomonads and visualise flagella

Question 21

When should a wet preparation microscopy slide be read following sampling?

Answer 21

within 10 minutes

Question 22

Why should a wet preparation slide be read within 10 minutes for investigation of T vaginalis?

Answer 22

Trichomonads quickly LOSE MOTILITY and more DIFFICULT to IDENTIFY

Question 23

What is the sensitivity of microscopy for T vaginalis?

Answer 23

45-60%

Question 24

In what setting are false positive results more likely when performing Trichomonad Rapid Test for T vaginalis infection?

Answer 24

In populations with a LOW PREVALENCE of disease

Question 25

What is the 'gold standard' for T vaginalis testing?

Answer 25

nucleic acid amplification tests (NAATs)

Question 26

If testing for T vaginalis what other testing should take place?

Answer 26

screening for co-existent STIs

Question 27

What antibiotic class can be used to treat T vaginalis?

Answer 27

almost any NITROIMIDAZOLE drug (Cochrane review)

Question 28

How effective is a nitroimidazole at treating T vaginalis?

Answer 28

>90% cure rate

Question 29

Why is a single high dose nitroimidazole not as acceptable as a longer lower dose for T vaginalis?

Answer 29

associated with more frequent SIDE EFFECTS

Question 30

What are the regimen options for T vaginalis treatment? (3)

Answer 30

Metronidazole 2 g orally in a single dose Metronidazole 400–500 mg twice daily for 5–7 days Tinidazole 2g orally in a single dose

Question 31

Can metronidazole be used in pregnancy?

Answer 31

Yes however some clinicians may avoid in first trimester

Question 32

What should be avoided if prescribing metronidazole to a breast feeding woman?

Answer 32

HIGH DOSE metronidazole or | discontinue breast feeding 12-24 hours to reduce infant exposure

Question 33

Which regimen may not be as effective for treatment of TV in HIV-positive women?

Answer 33

Single high dose metronidazole

Question 34

What should patients avoid whilst taking metronidazole? Why?

Answer 34

alcohol - duration of treatment and 48 h after | Disulfiram-like reaction - nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort

Question 35

In the event of persistent or recurrent TV what should you do?

Answer 35

Check: COMPLIANCE and exclude vomiting of metronidazole . Sexual history for possibility of RE-INFECTION and ask if partner(s) have been treated

Question 36

What are the benefits of tinidazole vs metronidazole for TV?

Answer 36

longer serum half-life good tissue penetration a better side-effect profile lower levels of resistance

Question 37

When should tinidazole be used for TV infection?

Answer 37

when infections have not responded to metronidazole

Question 38

Why should metronidazole 400mg twice daily for 7 days be the first line therapy for non-response to first course treatment of TV?

Answer 38

in those who failed to respond to a first course of treatment, 40% responded to a repeat course

Question 39

If a person fails treatment with standard therapy metronidazole what are the options for TV infection?

Answer 39

HIGHER DOSE metronidazole or tinidazole 2gram FIVE-SEVEN days Metronidazole 800mg 3 times daily for 7 days

Question 40

In those who have failed repeat treatment with standard therapy metronidazole for TV, what percentage respond to a higher dose?

Answer 40

70%

Question 41

In those who had failed other treatments, 92% and 90% | responded to a VERY HIGH DOSE course of tinidazole - what is this regimen?

Answer 41

Tinidazole 1 g twice or three times daily for 14 days Tinidazole 2 g twice daily for 14 days 􏰂 (intravaginal tinidazole 500 mg twice daily for 14 days can be added to oral therapy)

Question 42

How far back should contact tracing be for TV?

Answer 42

current and previous partners within 4 weeks of presentation

Question 43

If a male contact of TV has urethritis on screening, what should first line treatment be?

Answer 43

treat for TV | repeat urethral smear before considering treatment of NGU