Trichomoniasis

"Trich" redirects here. For the hair-pulling disorder, see Trichotillomania.
Not to be confused with Trichinosis or Trichuriasis.
Trichomoniasis
Micrograph showing a positive result for trichomoniasis. A trichomonas organism is seen on the top-right of the image.
Classification and external resources
Specialty Gynecology
ICD-10 A59
ICD-9-CM 131,007.3
DiseasesDB 13334
MedlinePlus 001331
eMedicine med/2308 emerg/613
MeSH D014246

Trichomoniasis is an infectious disease caused by the parasite Trichomonas vaginalis.[1] About 70% of women and men do not have symptoms when infected.[1] When symptoms do occur they typically begin 5 to 28 days after exposure.[2] Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex.[2][1] Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy.[2]

Trichomoniasis is a sexually transmitted infection (STI) which is most often spread through vaginal, oral, or anal sex. It can also spread through genital touching.[2] People who are infected may spread the disease even when symptoms are not present.[1] Diagnosis is by finding the parasite in the vaginal fluid using a microscope, culturing the vagina or urine, or testing for the parasites DNA. If present other sexually transmitted infections should be tested for.[2]

Methods of prevention include not having sex, using condoms, not douching, and being tested for STIs before having sex with a new partner. Trichomoniasis can be cured with antibiotics, either metronidazole or tinidazole. Sexual partners should also be treated.[2] About 20% of people get infected again within three months of treatment.[1]

There were about 58 million cases of trichomoniasis in 2013.[3] In the United States there are about 2 million women affected. It occurs more often in women than men.[2] Trichomonas vaginalis was first identified in 1836 by Alfred Donné.[4] It was first recognized as causing this disease in 1916.[5]

Signs and symptoms

Most people infected with trichomonas vaginalis do not have any symptoms.[6] Symptoms experienced include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase during intercourse and urination. For women there may also be a yellow-green, itchy, frothy, foul-smelling ("fishy" smell) vaginal discharge. In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure.[7]

Causes

Lifecycle of Trichomonas

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.[8]

The single-celled protozoan produces mechanical stress on host cells and then ingesting cell fragments after cell death.[9]

Genetic sequence

A draft sequence of the Trichomonas genome was published on January 12, 2007 in the journal Science confirming that the genome has at least 26,000 genes, a similar number to the human genome. An additional ~35,000 unconfirmed genes, including thousands that are part of potentially transposable elements, brings the gene content to well over 60,000.[10]

Diagnosis

There are three main ways to test for Trichomoniasis.

Prevention

Use of male condoms may help prevent the spread of trichomoniasis,[15] although careful studies have never been done that focus on how to prevent this infection. Infection with Trichomoniasis through water is unlikely because Trichomonas vaginalis dies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in diluted urine after 5–6 hours.[16]

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing.[17][18] The Centers for Disease Control and Prevention (CDC) recommends Trichomoniasis testing for females with vaginal discharge[19] and can be considered for females at higher risk for infection or of HIV-positive serostatus.[17]

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women.[17][20] Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis in the U.S., which can lead to better prevention efforts.[17][20]

A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments.[21]

Screening

Evidence from a randomized controlled trials for screening pregnant women who do not have symptoms for infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of preterm birth.[22][23] Further studies are needed to verify this result and determine the best method of screening. In the US, screening of pregnant women without any symptoms is only recommended in those with HIV as trichomonas infection is associated with increased risk of transmitting HIV to the fetus.[24]

Treatment

Treatment for both pregnant and non-pregnant people is usually with metronidazole,[25] by mouth once.[24] Caution should be used in pregnancy, especially in the first trimester.[26] Sexual partners, even if they have no symptoms, should also be treated.[16]

For 95-97% of cases, infection is resolved after one dose of metronidazole.[19][27] Studies suggest that 4-5% of trichomonas cases are resistant to metronidazole, which may account for some “repeat” cases.[28][29] Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men.[29] Women living with HIV infection have better cure rates if treated for 7 days rather than with one dose.[24][30]

Complications

Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that:

Epidemiology

There were about 58 million cases of trichomoniasis in 2013.[3] It is more common in women (2.7%) than males (1.4%).[35] It is the most common non-viral STI in the U.S., with an estimated 3.7 million prevalent cases and 1.1 million new cases per year.[36][37] It is estimated that 3% of the general U.S. population is infected,[14][38] and 7.5-32% of moderate-to-high risk (including incarcerated) populations.[39][40][41][42][43][44][45][46]

References

  1. 1 2 3 4 5 "Trichomoniasis - CDC Fact Sheet". CDC. November 17, 2015. Retrieved 21 March 2016.
  2. 1 2 3 4 5 6 7 "Trichomoniasis". Office on Women's Health. August 31, 2015. Retrieved 21 March 2016.
  3. 1 2 Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England). 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMID 26063472.
  4. ↑ Wiser, Mark (2010). Protozoa and Human Disease. Garland Science. p. 60. ISBN 9781136738166.
  5. ↑ Pearson, Richard D. (2001). Principles and Practice of Clinical Parasitology. Chichester: John Wiley & Sons. p. 243. ISBN 9780470851722.
  6. ↑ "STD Facts - Trichomoniasis". cdc.gov.
  7. ↑ Trichomoniasis symptoms. cdc.gov
  8. ↑ "Trichomoniasis - CDC Fact Sheet". Retrieved 12 January 2011.
  9. ↑ Midlej V.; Benchimol M. (2010). "Trichomonas vaginalis kills and eats- evidence for phagocytic activity as a cytopathic effect". Parasitology. 137 (1): 65–76. doi:10.1017/S0031182009991041. PMID 19723359.
  10. ↑ Scientists crack the genome of the parasite causing trichomoniasis. Physorg.com. Jan. 12, 2007.
  11. ↑ Fouts AC, Kraus SJ (1980). "Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis". J Infect Dis. 141 (2): 137–143. doi:10.1093/infdis/141.2.137.
  12. ↑ Schwebke JR, Burgess D (2004). "Trichomoniasis". Clin Microbiol Rev. 17: 794–803.
  13. 1 2 Nye MB, Schwebke JR, Body BA. "Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women" Am J Obstet Gynecol 2008;200(2):188e1–188e2.
  14. 1 2 Ginocchio C, Chapin K (2012). "Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay". J Clin Microbiol. 50 (8): 2601–2608. doi:10.1128/JCM.00748-12.
  15. ↑ Vaginitis/Trichomoniasis :Reduce your risk, American Social Health Association. Retrieved March 12, 2008.
  16. 1 2 Rob, Lukáš; Martan, Alois; Citterbart, Karel; et al. (2008). Gynekologie (in Czech) (2nd ed.). Prague: Galen. p. 136. ISBN 978-80-7262-501-7.
  17. 1 2 3 4 Munson E (2014). "Point: new trichs for "old" dogs: prospects for expansion of Trichomonas vaginalis screening". Clin Chem. 60 (1): 151–4. doi:10.1373/clinchem.2013.210021.
  18. ↑ Wendel KA, Workowski KA (2007). "Trichomoniasis: challenges to appropriate management". Clin Infect Dis. 44 (Suppl 3): S123–S129. doi:10.1086/511425.
  19. 1 2 Workowski KA, Berman S. "Sexually transmitted diseases treatment guidelines, 2010" MMWR Recomm Rep 2010;59(RR-12):1–110.
  20. 1 2 Smith LV, Sorvillo F, Kuo T (2013). "Implications of Trichomonas vaginalis nucleic acid amplification testing on medical training and practice". J Clin Microbiol. 51 (5): 1650. doi:10.1128/JCM.00188-13.
  21. ↑ Desai, Monica; Woodhall, Sarah C; Nardone, Anthony; Burns, Fiona; Mercey, Danielle; Gilson, Richard (2015). "Active recall to increase HIV and STI testing: a systematic review". Sexually Transmitted Infections: sextrans–2014–051930. doi:10.1136/sextrans-2014-051930. ISSN 1368-4973: Access provided by the University of Pittsburgh Library System
  22. ↑ Klebanoff, Mark A.; Carey, J. Christopher; Hauth, John C.; Hillier, Sharon L.; Nugent, Robert P.; Thom, Elizabeth A.; Ernest, J.M.; Heine, R. Phillip; Wapner, Ronald J. (2001-08-16). "Failure of Metronidazole to Prevent Preterm Delivery among Pregnant Women with Asymptomatic Trichomonas vaginalis Infection". New England Journal of Medicine. 345 (7): 487–493. doi:10.1056/NEJMoa003329. ISSN 0028-4793. PMID 11519502.
  23. ↑ McGregor, James A.; French, Janice I.; Parker, Ruth; Draper, Deborah; Patterson, Elisa; Jones, Ward; Thorsgard, Kyja; McFee, John. "Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation". American Journal of Obstetrics and Gynecology. 173 (1): 157–167. doi:10.1016/0002-9378(95)90184-1.
  24. 1 2 3 Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  25. ↑ Vaginitis/Trichomoniasis :Treatment for trichomoniasis, American Social Health Association. Retrieved March 12, 2008.
  26. ↑ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE (October 2004). "Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis". Clin. Microbiol. Rev. 17 (4): 783–93, table of contents. doi:10.1128/CMR.17.4.783-793.2004. PMC 523556Freely accessible. PMID 15489348.
  27. ↑ Niccolai LM, Kopicko JJ, Kassie A, Petros H, Clark RA, Kissinger P (2000). "Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women". Sex Transm Dis. 27 (5): 284–288. doi:10.1097/00007435-200005000-00009.
  28. ↑ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE. "Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis. Clin Microbiol Rev. 2004;17(4):783–93, table of contents. doi:10.1128/CMR.17.4.783-793.2004
  29. 1 2 3 4 Secor W, Meites E, Starr M, Workowski K (2014). "Neglected parasitic infections in the United States: trichomoniasis". Am J Trop Med Hyg. 90 (5): 800–804. doi:10.4269/ajtmh.13-0723.
  30. ↑ Kissinger, Patricia; Mena, Leandro; Levison, Judy; Clark, Rebecca A; Gatski, Megan; Henderson, Harold; Schmidt, Norine; Rosenthal, Susan L; Myers, Leann. "A Randomized Treatment Trial: Single Versus 7-Day Dose of Metronidazole for The Treatment of Trichomonas Vaginalis Among HIV-Infected Women". JAIDS Journal of Acquired Immune Deficiency Syndromes. 55 (5): 565–571. doi:10.1097/qai.0b013e3181eda955.
  31. ↑ Kissinger P, Adamski A. "Trichomoniasis and HIV interactions: a review.". nih.gov.
  32. ↑ Donders GG; et al. (2013). "Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women.". nih.gov. 8: e86266. doi:10.1371/journal.pone.0086266. PMC 3875579Freely accessible. PMID 24386492.
  33. ↑ Caini, Saverio; Gandini, Sara; Dudas, Maria; Bremer, Viviane; Severi, Ettore; Gherasim, Alin (2014). "Sexually transmitted infections and prostate cancer risk: A systematic review and meta-analysis". Cancer Epidemiology. 38 (4): 329–338. doi:10.1016/j.canep.2014.06.002. ISSN 1877-7821. PMID 24986642.
  34. ↑ Stark, Jennifer R.; Judson, Gregory; Alderete, John F.; Mundodi, Vasanthakrishna; Kucknoor, Ashwini S.; Giovannucci, Edward L.; Platz, Elizabeth A.; Sutcliffe, Siobhan; et al. (2009). "Prospective Study of Trichomonas vaginalis Infection and Prostate Cancer Incidence and Mortality: Physicians' Health Study". JNCI Journal of the National Cancer Institute. 101 (20): 1406–11. doi:10.1093/jnci/djp306. PMC 2765259Freely accessible. PMID 19741211.
  35. ↑ Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
  36. ↑ Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, and TB. Division of STD Prevention. Trichomoniasis - CDC Fact Sheet. 2012.
  37. ↑ Satterwhite CL, Torrone E, Meites E, et al. (2013). "Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008". Sex Transm Dis. 40 (3): 187–93. doi:10.1097/OLQ.0b013e318286bb53.
  38. ↑ Sutton M, Sternberg M, Koumans EH, Mcquillan G, Berman S (2007). "The Prevalence of Trichomonas vaginalis Infection among Reproductive-Age Women in the United". Clin Infect Dis. 45: 1319–1626. doi:10.1086/522532.
  39. ↑ Rogers SM, Turner CF, Hobbs M, et al. (2014). "Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults". PLOS ONE. 9 (3): e90548. doi:10.1371/journal.pone.0090548.
  40. ↑ Javanbakht M, Stirland A, Stahlman S, et al. (2013). "Prevalence and Factors Associated With Trichomonas vaginalis Infection Among High-Risk Women in Los Angeles". Sex Transm Dis. 40 (10): 804–807. doi:10.1097/OLQ.0000000000000026.
  41. ↑ Helms DJ, Mosure DJ, Metcalf C, et al. (2008). "Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics". Sex Transm Dis. 35 (5): 484–8. doi:10.1097/OLQ.0b013e3181644b9c.
  42. ↑ Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES (2014). "Correlates of incident Trichomonas vaginalis infections among African American female adolescents". Sex Transm Dis. 41 (4): 240–5. doi:10.1097/OLQ.0000000000000094.
  43. ↑ Muzny C, Rivers C, Austin EL, Schwebke JR (2013). "Trichomonas vaginalis infection among women receiving gynaecological care at an Alabama HIV Clinic". Sex Transm Infect. 89 (6): 514–8. doi:10.1136/sextrans-2012-050889.
  44. ↑ Munson E, Kramme T, Napierala M, Munson KL, Miller C, Hryciuk JE (2012). "Female epidemiology of transcription-mediated amplification-based Trichomonas vaginalis detection in a metropolitan setting with a high prevalence of sexually transmitted infection". J Clin Microbiol. 50 (12): 3927–31. doi:10.1128/JCM.02078-12.
  45. ↑ Freeman AH, Katz KA, Pandori MW, et al. Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay. Sex Transm Dis. 2010;37(3):165–168. doi:10.1097/OLQ.0b013e3181bcd3fc
  46. ↑ Nijhawan AE, DeLong AK, Celentano DD, et al. (2011). "The Association Between Trichomonas Infection and Incarceration in HIV-Seropositive and At-Risk HIV-Seronegative Women". Sex Transm Dis. 38 (12): 1094–1100. doi:10.1097/OLQ.0b013e31822ea147.
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