Trichomoniasis Flashcards
What is trichomoniasis?
A curable sexually transmitted infection caused by the protozoan trichomonas vaginalis (TV)
How common is trichomoniasis?
The most common curable STI worldwide
What is happening to the incidence and prevalence of trichomoniasis?
Decreasing
How does the incidence of trichomoniasis in the UK compare to worldwide statistics?
Less common - 7000 cases in 2016
What age group is trichomoniasis most common in?
Under 25s
Which ethnic group is trichomoniasis most common in?
Black
How is trichomonas vaginalis transmitted?
- Vaginal sexual intercourse
- Rarely vertical transmission at delivery
Is trichomonas vaginalis spread through oral or anal sex?
No
What type of organism is trichomonas vaginalis?
Anaerobic flagellated protozoan
Does trichomonas vaginalis affect males or females?
Both
Where can trichomonas vaginalis infect in women?
- Urethra
- Vagina
- Paraurethral glands
Where can trichomonas vaginalis affect in men?
- Urethra
- Underneath foreskin
What site is most commonly affected by trichomonas vaginalis?
Urethra
How many sites are often affected by trichomonas vaginalis?
More than one
How does trichomonas vaginalis affect the site it colonises?
Replicates via binary fission whilst destroying epithelial cells through direct cell contact and by the release of cytotoxins
How can trichomonas vaginalis affect the immune system?
Binds to host plasma proteins preventing recognition by complement pathway
What can trichomonas vaginalis infection increase the risk of contracting?
HIV
What are the risk factors for trichomoniasis?
- Multiple sexual partners
- Unprotected sexual intercourse
- History of other STIs
- Older women
What proportion of trichomoniasis cases are symptomatic?
Many
In which gender is asymptomatic trichomoniasis more common?
Men
How do most men with trichomoniasis present?
As a partner of a symptomatic infected woman
When do symptoms of trichomoniasis develop after infection?
Within 28 days
What are the symptoms of trichomoniasis in women?
- Offensive vaginal discharge
- Abnormal vaginal discharge
- Itchiness or soreness of the vulva
- Dyspareunia
- Dysuria
What is the appearance of the discharge in trichomoniasis?
Can be thick or thin and frothy yellow-green colour
What are the symptoms of trichomoniasis in men?
- Urethral discharge
- Dysuria
- Urinary frequency
- Pain or itching around foreskin
What are the signs of trichomoniasis in women?
- Abnormal vaginal discharge
- Vulvitis
- Vaginitis
- Strawberry cervix
What is a strawberry cervix?
Punctate and papilliform appearance
What are the signs of trichomoniasis in men?
- Urethral discharge
- Balanoposthitis
What is balanoposthitis?
Inflammation of the glans penis
How common is balanoposphitis?
Rare
What are the differentials for trichomoniasis?
- Other vaginal infections
- Other causes of vaginal discharge
- Atrophic vaginitis
- Post-surgery discharge
- Other causes of prostatitis, cervicitis and cystitis
What are some other vaginal infections?
- Candidiasis
- BV
- Chlamydia
- Gonorrhoea
What are some benign causes of vaginal discharge?
- Physiological
- Chemical irritants
- Pregnancy
What steps are important to attempt to diagnose trichomoniasis before investigations?
- History
- Examination
How is trichomoniasis investigated?
Culture and sensitivity testing
How are sample obtained for trichomoniasis culture testing in women?
- High vaginal swab from posterior fornix
- OR self administered vaginal swab
How are samples obtained for trichomoniasis culture testing in men?
- Urethral swab
- First void urine sample
What is required if a patient tests positive for trichomoniasis?
- Contact tracing
- Full STI screen
What type of medication is used to treat trichomoniasis?
Anti-protozoan
What is the drug of choice for trichomoniasis in men and non-pregnant/breast-feeding women?
Metronidazole
What are the treatment regimes for trichomoniasis with metronidazole?
- 2g orally as single dose
- OR 400-500mg BD for 5-7 days
What is an alternative single dose medication for trichomoniasis?
2g tinidazole
Which contacts should be tested for trichomoniasis?
Any current or previous sexual partners in the preceding 4 weeks
For how long should patients with trichomoniasis abstain from sex?
- Whilst being treated
- OR 1 week after single dose
When is a test of cure required for trichomoniasis?
- Patient is not responding to treatment
- Re-infected
What is the risk of trichomoniasis in pregnancy?
- Pre-term labour
- Low birth weight
- Maternal post-partum sepsis
How is trichomoniasis treated differently in pregnancy?
Avoid high (single) dose metronidazole
How is trichomoniasis treated when breast feeding?
- Avoid single dose
- OR avoid breast feeding for 12-24 hours after single dose
