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DipGUM > Trichomonas vaginalis > Flashcards

Trichomonas vaginalis Flashcards

1
Q

What type of organism is trichomonas vaginalis?

A

Flagellated protozoon

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2
Q

Where in women is T vaginalis infection found?

A

Vagina
Urethra
Paraurethral glands

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3
Q

Where in men is T vaginalis infection found?

A

Urethra
Subpreputial sac
Lesions of the penis

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4
Q

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

A 
Asymptomatic
Vaginal discharge
Vulval itching
Dysuria
Offensive odour
Lower abdominal pain
Vulval ulceration
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5
Q

How often is T vaginalis asymptomatic in women?

A

10-50%

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6
Q

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

A

Urethral discharge
Dysuria
Urethral irritation
Urinary frequency

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7
Q

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

A

Urethral discharge

Dysuria

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8
Q

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

A

Frothy yellow discharge

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9
Q

How common is frothy yellow discharge in T vaginalis infection?

A

10-30%

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10
Q

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

A

Strawberry cervix

2%

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11
Q

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

A

70%

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12
Q

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

A

77%

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13
Q

What impact may T vaginalis infection have on a pregnancy?

A

Preterm delivery

Low birth weight

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14
Q

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

A

Predispose to maternal postpartum SEPSIS

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15
Q

When should women have testing for T vaginalis?

A

Vaginal discharge
Vulvitis
Evidence of vulvitis or vaginitis on examination

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16
Q

When should men have testing for T vaginalis?

A

TV contacts

Persistent urethritis

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17
Q

What is the preferred specimen for T vaginalis in women?

A

Swab of posterior fornix during speculum

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18
Q

What specimen is required for T vaginalis in men?

A

Urethral swab OR

first void urine

19
Q

How sensitive is testing for T vaginalis in men?

A

60-80% with urethral or FVU culture

Sampling both sites significantly increases diagnostic rate

20
Q

Microscopy - T vaginalis - describe the steps?

A

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

21
Q

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

A

within 10 minutes

22
Q

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

A

Trichomonads quickly LOSE MOTILITY and more DIFFICULT to IDENTIFY

23
Q

What is the sensitivity of microscopy for T vaginalis?

A

45-60%

24
Q

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

A

In populations with a LOW PREVALENCE of disease

25
Q

What is the ‘gold standard’ for T vaginalis testing?

A

nucleic acid amplification tests (NAATs)

26
Q

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

A

screening for co-existent STIs

27
Q

What antibiotic class can be used to treat T vaginalis?

A

almost any NITROIMIDAZOLE drug (Cochrane review)

28
Q

How effective is a nitroimidazole at treating T vaginalis?

A

> 90% cure rate

29
Q

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

A

associated with more frequent SIDE EFFECTS

30
Q

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

A

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

31
Q

Can metronidazole be used in pregnancy?

A

Yes however some clinicians may avoid in first trimester

32
Q

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

A

HIGH DOSE metronidazole or

discontinue breast feeding 12-24 hours to reduce infant exposure

33
Q

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

A

Single high dose metronidazole

34
Q

What should patients avoid whilst taking metronidazole? Why?

A

alcohol - duration of treatment and 48 h after

Disulfiram-like reaction - nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort

35
Q

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

A

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

36
Q

What are the benefits of tinidazole vs metronidazole for TV?

A

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

37
Q

When should tinidazole be used for TV infection?

A

when infections have not responded to metronidazole

38
Q

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

A

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

39
Q

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

A

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

40
Q

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

A

70%

41
Q

In those who had failed other treatments, 92% and 90%

responded to a VERY HIGH DOSE course of tinidazole - what is this regimen?

A

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)

42
Q

How far back should contact tracing be for TV?

A

current and previous partners within 4 weeks of presentation

43
Q

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

A

treat for TV

repeat urethral smear before considering treatment of NGU

DipGUM (39 decks)

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