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Trichomonas

Terms in this set (11)

Trichomoniasis definition
Trichomoniasis is a genitourinary infection with the protozoan Trichomonas vaginalis. It is the most common non-viral sexually transmitted disease (STD) worldwide. Women are affected more often than men. Trichomoniasis is one of the three major causes of vaginal complaints among reproductive aged women, along with bacterial vaginosis and candida vulvovaginitis, and a cause of urethritis in men; however, the infection is often asymptomatic.
Trichomoniasis History
Chief concern (CC):
· if present, symptoms in women may include vulvar pruritus, burning, profuse vaginal discharge, rancid odor, and postcoital bleeding
· many women have few or no symptoms
· men may not have symptoms or may have symptoms of urethritis, epididymitis, or prostatitis
Trichomoniasis Physical
Pelvic:
· assess for diffuse foul-smelling, greenish-yellow vaginal discharge, also may have vaginal tenderness
Trichomoniasis Testing
in women
· nucleic acid amplification test
· motile T. vaginalis on wet mount of vaginal secretions
· culture for T. vaginalis if trichomoniasis suspected but not confirmed on wet mount

in men
· culture for T. vaginalis from urethral swab, urine, or semen
Trichomoniasis Differential diagnosis
· bacterial vaginosis
· candida vulvovaginitis
· mechanical, chemical or allergic irritations of the vulva
· gonococcal cervicitis
· chlamydial genital infection
Trichomoniasis Testing overview
pH testing of vaginal secretions:
-elevated pH (>4.5) common in trichomoniasis and bacterial vaginosis

Wet mount of vaginal secretions:
-obtain sample of vaginal secretion and dilute with 1-2 drops of saline on a slide, immediately look for motile T. vaginalis

Culture for T. vaginalis:
-vaginal secretions in women if trichomoniasis suspected but not confirmed on wet mount
-urethral swab, urine or semen in men
Trichomoniasis Treatment
Recommended treatment includes 1 of
• metronidazole 2 g orally in single dose -OR-
• tinidazole 2 g orally in single dose

Alternative treatment
-metronidazole 500 mg orally twice daily for 7 days



· rescreening at 3 months recommended due to high risk for new asymptomatic sexually transmitted infections
Trichomoniasis Treatment considerations
• antimicrobial gels < 50% effective and not recommended
• avoid consumption of alcohol during treatment and for 24 hours after completion of metronidazole and 72 hours after completion of tinidazole (or metronidazole in oral capsules or extended-release tablets)
• allergic patients may be desensitized to metronidazole with specialist consultation
• consider using multidose regimen of metronidazole in patients with HIV infection
o treat sexual partners and avoid sex until completion of treatment and asymptomatic
o for treatment failures with metronidazole 2 g single dose, if reinfection excluded, use metronidazole 500 mg orally twice daily for 7 days
o for persistent treatment failure, consider using tinidazole or metronidazole 2 g/day orally for 7 days
o obtain consult if unresponsive to therapies
Trichomoniasis Treatment in pregnancy and breastfeeding
pregnancy
-consider treatment with metronidazole 2 g orally in single dose at any stage of pregnancy
-counsel patients regarding potential risks and benefits of treatment
-metronidazole during pregnancy may reduce rate of trichomoniasis but may increase rate of preterm birth

lactation
-with metronidazole, withhold breastfeeding during treatment and for 12-24 hours after last dose
-with tinidazole, withhold breastfeeding during treatment and for 3 days after last dose
Trichomoniasis Complications
vaginal trichomoniasis associated with adverse pregnancy outcomes
o premature rupture of membranes at term (term PROM) or preterm premature rupture of membranes (PPROM)
o preterm delivery
o low birth weight
· most male sex partners of women with trichomoniasis have asymptomatic trichomoniasis
Trichomoniasis Screening
consider screening women at high risk for infection (women with multiple sex partners, history of sexually transmitted diseases, injection drug use)
· screen sexually active women with HIV infection for trichomoniasis at least annually
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