Trichomoniasis

Question 1

What is trichmoniasis?

Answer 1

Trichomonas vaginalis is a type of parasite spread through sexual intercourse.

Question 2

How is trichomoniasis spread?

Answer 2

Trichomonas is spread through sexual activity and lives in the urethra of men and women and the vagina of women.

Question 3

Briefly describe trichomoniasis

Answer 3

Trichomonas is classed as a protozoan, and is a single-celled organism with flagella. Flagella are appendages stretching from the body, similar to limbs. Trichomonas has four flagella at the front and a single flagellum at the back, giving a characteristic appearance to the organism. The flagella are used for movement, attaching to tissues and causing damage.

Question 4

What can trichomoniasis infection increase the risk of?

Answer 4

Trichomonas can increase the risk of:

• Contracting HIV by damaging the vaginal mucosa
• Bacterial vaginosis
• Cervical cancer
• Pelvic inflammatory disease
• Pregnancy-related complications such as preterm delivery.

Question 5

How does trichomoniasis present?

Answer 5

Up to 50% of cases of trichomoniasis are asymptomatic. When symptoms occur, they are non-specific:

• Vaginal discharge
• Itching
• Dysuria (painful urination)
• Dyspareunia (painful sex)
• Balanitis (inflammation to the glans penis)

The typical description of the vaginal discharge is frothy and yellow-green, although this can vary significantly. It may have a fishy smell.

Question 6

How does trichomoniasis present on examiantion?

Answer 6

Examination of the cervix can reveal a characteristic “strawberry cervix” (also called colpitis macularis). A strawberry cervix is caused by inflammation (cervicitis) relating to the trichomonas infection. There are tiny haemorrhages across the surface of the cervix, giving the appearance of a strawberry.

Question 7

How does trichnomoniasis change vaginal pH?

Answer 7

Testing the vaginal pH will reveal a raised ph (above 4.5), similar to bacterial vaginosis.

Question 8

Briefly describe the diagnosis of trichomoniasis

Answer 8

The diagnosis can be confirmed with a standard charcoal swab with microscopy (examination under a microscope).

Swabs should be taken from the posterior fornix of the vagina (behind the cervix) in women. A self-taken low vaginal swab may be used as an alternative.

A urethral swab or first-catch urine is used in men.

Question 9

Briefly describe the treatment of trichomoniasis

Answer 9

Patients should be referred to a genitourinary medicine (GUM) specialist service for diagnosis, treatment and contact tracing.

Treatment is with metronidazole.