Trichomonas Vaginalis (TV) Flashcards
Is TV a sexually transmitted infection?
Yes
- Trichomonas vaginalis is transmitted through unprotected vaginal sexual intercourse
- not passed on through oral or anal sex
- rarely it is also possible for an infected mother to vertically transmit the disease to the neonate at delivery
What microorganism causes TV?
Trichomonas vaginalis is an anaerobic flagellated protozoan
What areas of the body can be affected by TV infection?
(both in men and women)
- female: urethra, vagina and paraurethral glands
- male: urethra and underneath the foreskin
How does TV replicate?
TV replicates:
- via binary fission → destroying epithelial cells through direct cell contact and by the release of cytotoxins
- It also binds host plasma proteins, preventing recognition by the complement pathway
*It is thought that this destruction may also lead to an increased risk of contracting HIV
Risk factors for TV
- Multiple sexual partners
- Unprotected sexual intercourse
- A history of other STIs
- Older women are more at risk of TV
Is TV symptomatic or asymptomatic?
- many cases of TV infection are asymptomatic, especially in men, who often present as a partner of an infected woman
- If symptomatic, signs and symptoms usually develop within 28 days following infection
Symptoms of TV in female
- Offensive vaginal odour
- Abnormal vaginal discharge – thick/thin/frothy and yellow-green
- Itchiness or soreness of the vulva
- Dyspareunia
- Dysuria
Signs of TV infection in female
- Abnormal vaginal discharge – thick/thin/frothy and yellow-green
- Vulvitis
- Vaginitis
- Strawberry cervix – punctate and papilliform appearance
Symptoms of TV infection in male
- Urethral discharge
- Dysuria
- Urinary frequency
- Pain or itching around the foreskin
Signs of TV infection in male
- Urethral discharge
- Balanoposthitis – inflammation of the glans penis (rare)
What Ix to do if TV is suspected based on examination and history?
- specimens are taken to be cultured and sensitivity established
- if in a specialist centre, on site microscopy may reveal TV
(2) types of swabs taken from a female with suspected TV
- High vaginal swab is taken from the posterior fornix during examination
OR
- Self-administered vaginal swab
(2) types of swabs taken form a man with suspected TV
- Urethral swab
OR
- First void urine sample
What (apart from medical treatment) to do if a patient is tested positive for TV?
- contact tracing is required (current and previous 4 weeks sexual partners) -> to be tested and treated
- to abstain from sexual intercourse whilst being treated or at least one week following the single dose
- full STI screen for coexisting infections
- Bloods may be required if there are systemic features of infection
Medical management of TV for men and non-pregnant/ non- breast feeding women
Anti-protozoan antibiotics:
- Metronidazole 2g orally in a single dose
OR
- Metronidazole 400-500mg twice daily for 5-7 days
Alternatives to the recommended regimes:
Tinidazole 2g orally in a single dose
