Trichomoniasis

File:Trichomonas vaginalis.webm

Most people infected with Trichomonas vaginalis do not have any symptoms and it can be undetected for years.{{cite web|url=https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm|title=STD Facts - Trichomoniasis|work=cdc.gov|url-status=live|archive-url=https://web.archive.org/web/20130219210323/http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm|archive-date=2013-02-19}} Symptoms 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.[https://www.cdc.gov/STD/Trichomonas/STDFact-Trichomoniasis.htm#symptoms Trichomoniasis symptoms] {{webarchive|url=https://web.archive.org/web/20130219210323/http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm |date=2013-02-19 }}. cdc.gov Sometimes trichomoniasis can be confused with chlamydia because the symptoms are similar.{{cite web |title=Can Trichomoniasis Be Confused With Chlamydia? |url=https://www.mylabbox.com/chlamydia-trichomoniasis-confusion/ |website=mylabbox.com |date=6 March 2019 |access-date=18 July 2019}}

Trichomoniasis is linked to several serious complications.

• Trichomoniasis is associated with an increased risk of transmission and infection of HIV.{{cite journal | vauthors = Kissinger P, Adamski A | title = Trichomoniasis and HIV interactions: a review | journal = Sexually Transmitted Infections | volume = 89 | issue = 6 | pages = 426–33 | date = September 2013 | pmid = 23605851 | pmc = 3748151 | doi = 10.1136/sextrans-2012-051005 }}
• Trichomoniasis may cause a woman to deliver a low-birth-weight or premature infant.
• The role of Trichomonas infection in causing cervical cancer is unclear. However, trichomonas infection may be associated with co-infection with high-risk strains of HPV.{{cite journal | vauthors = Donders GG, Depuydt CE, Bogers JP, Vereecken AJ | title = Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low-risk women | journal = PLOS ONE | volume = 8 | issue = 12 | pages = e86266 | date = 30 December 2013 | pmid = 24386492 | pmc = 3875579 | doi = 10.1371/journal.pone.0086266 | bibcode = 2013PLoSO...886266D | doi-access = free }}
• T. vaginalis infection in males has been found to cause asymptomatic urethritis and prostatitis. In the prostate, it may create chronic inflammation that may eventually lead to prostate cancer.{{cite journal | vauthors = Caini S, Gandini S, Dudas M, Bremer V, Severi E, Gherasim A | title = Sexually transmitted infections and prostate cancer risk: a systematic review and meta-analysis | journal = Cancer Epidemiology | volume = 38 | issue = 4 | pages = 329–38 | date = August 2014 | pmid = 24986642 | doi = 10.1016/j.canep.2014.06.002 }}{{cite journal | vauthors = Stark JR, Judson G, Alderete JF, Mundodi V, Kucknoor AS, Giovannucci EL, Platz EA, Sutcliffe S, Fall K, Kurth T, Ma J, Stampfer MJ, Mucci LA | display-authors = 6 | title = Prospective study of Trichomonas vaginalis infection and prostate cancer incidence and mortality: Physicians' Health Study | journal = Journal of the National Cancer Institute | volume = 101 | issue = 20 | pages = 1406–11 | date = October 2009 | pmid = 19741211 | pmc = 2765259 | doi = 10.1093/jnci/djp306 }}

Image:Trichomoniasis 01.png

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.{{cite web|url=https://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm|title=Trichomoniasis - CDC Fact Sheet|access-date=12 January 2011|url-status=live|archive-url=https://web.archive.org/web/20130219210323/http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm|archive-date=19 February 2013}}

The single-celled protozoan produces mechanical stress on host cells and then ingests cell fragments after cell death.{{cite journal | vauthors = Midlej V, Benchimol M | title = Trichomonas vaginalis kills and eats--evidence for phagocytic activity as a cytopathic effect | journal = Parasitology | volume = 137 | issue = 1 | pages = 65–76 | date = January 2010 | pmid = 19723359 | doi = 10.1017/S0031182009991041 | s2cid = 33988014 }}

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 approximately 34,000 unconfirmed genes, including thousands that are part of potentially transposable elements, brings the gene content to well over 60,000.[http://www.physorg.com/news87825794.html Scientists crack the genome of the parasite causing trichomoniasis] {{webarchive|url=https://web.archive.org/web/20090104101824/http://www.physorg.com/news87825794.html |date=2009-01-04 }}. Physorg.com. Jan. 12, 2007.

There are three main ways to test for trichomoniasis.

• The first is known as saline microscopy. This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope.{{cite book |last1=Epstein |first1=Aaron |last2=Roy |first2=Subir |chapter=Chapter 50: Vulvovaginitis |title=Management of Common Problems in Obstetrics and Gynecology |chapter-url=https://books.google.com/books?id=6vMopyn84isC&q=trichomoniasis+microscope+common&pg=PA228 |publisher=Wiley-Blackwell |editor-first1=T. Murphy |editor-last1=Goodwin |page=228 |date=2010 |quote=In 80% of cases, the diagnosis of trichomoniasis is confirmed by microscopic examination of the saline wet mount, with the observation of motile trichomonads; their shape is "football-like" with moving flagella. |edition=5th |isbn=978-1405169165 |url-status=live |archive-url=https://web.archive.org/web/20170215160416/https://books.google.com/books?id=6vMopyn84isC&pg=PA228&lpg=PA228&dq=trichomoniasis+microscope+common&source=bl&ots=2eEjEcMTle&sig=lh2SFRdDARtb3YvYD_ZiNHQBCLA&hl=en&sa=X&ved=0ahUKEwjIrO-l9eTRAhUFSCYKHW1sBD84FBDoAQg2MAQ#v=onepage&q=trichomoniasis%20microscope%20common&f=false |archive-date=2017-02-15 }} The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60–70%) often due to an inadequate sample, resulting in false negatives.{{cite journal | vauthors = Fouts AC, Kraus SJ | title = Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis | journal = The Journal of Infectious Diseases | volume = 141 | issue = 2 | pages = 137–143 | date = February 1980 | pmid = 6965976 | doi = 10.1093/infdis/141.2.137 }}{{cite journal | vauthors = Schwebke JR, Burgess D | title = Trichomoniasis | journal = Clinical Microbiology Reviews | volume = 17 | issue = 4 | pages = 794–803, table of contents | date = October 2004 | pmid = 15489349 | pmc = 523559 | doi = 10.1128/cmr.17.4.794-803.2004 }}
• The second diagnostic method is culture, which has historically been the "gold standard" in infectious disease diagnosis. Trichomonas vaginalis culture tests are relatively cheap but their sensitivity is still somewhat low (70–89%).{{cite journal | vauthors = Nye MB, Schwebke JR, Body BA | title = 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 | journal = American Journal of Obstetrics and Gynecology | volume = 200 | issue = 2 | pages = 188.e1–7 | date = February 2009 | pmid = 19185101 | doi = 10.1016/j.ajog.2008.10.005 }}
• The third method includes the nucleic acid amplification tests (NAATs), which are more sensitive. These tests are more costly than microscopy and culture, and are highly sensitive (80–90%).{{cite journal | vauthors = Ginocchio CC, Chapin K, Smith JS, Aslanzadeh J, Snook J, Hill CS, Gaydos CA | title = 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 | journal = Journal of Clinical Microbiology | volume = 50 | issue = 8 | pages = 2601–8 | date = August 2012 | pmid = 22622447 | pmc = 3421522 | doi = 10.1128/JCM.00748-12 }}

Use of male condoms or female condoms may help prevent the spread of trichomoniasis,[http://www.ashastd.org/learn/learn_vag_trich.cfm#8 Vaginitis/Trichomoniasis: Reduce your risk] {{webarchive|url=https://web.archive.org/web/20080316073148/http://www.ashastd.org/learn/learn_vag_trich.cfm |date=2008-03-16 }}, American Social Health Association. Retrieved March 12, 2008. although careful studies have never been done 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.

There are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing.{{cite journal | vauthors = Munson E | title = Point: new trichs for "old" dogs: prospects for expansion of Trichomonas vaginalis screening | journal = Clinical Chemistry | volume = 60 | issue = 1 | pages = 151–4 | date = January 2014 | pmid = 24043491 | doi = 10.1373/clinchem.2013.210021 | doi-access = free }}{{cite journal | vauthors = Wendel KA, Workowski KA | title = Trichomoniasis: challenges to appropriate management | journal = Clinical Infectious Diseases | volume = 44 | issue = Suppl 3 | pages = S123-9 | date = April 2007 | pmid = 17342665 | doi = 10.1086/511425 | doi-access = free }} The Centers for Disease Control and Prevention (CDC) recommends trichomoniasis testing for females with vaginal discharge{{cite journal | vauthors = Workowski KA, Berman S | title = Sexually transmitted diseases treatment guidelines, 2010 | journal = MMWR. Recommendations and Reports | volume = 59 | issue = RR-12 | pages = 1–110 | date = December 2010 | pmid = 21160459 }} and can be considered for females at higher risk for infection or of HIV-positive serostatus.

The advent of new, highly specific, and sensitive trichomoniasis tests presents opportunities for new screening protocols for both men and women.{{cite journal | vauthors = Smith LV, Sorvillo F, Kuo T | title = Implications of Trichomonas vaginalis nucleic acid amplification testing on medical training and practice | journal = Journal of Clinical Microbiology | volume = 51 | issue = 5 | pages = 1650 | date = May 2013 | pmid = 23592856 | pmc = 3647919 | doi = 10.1128/JCM.00188-13 }} 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, which can lead to better prevention efforts.

Several strategies have been found to improve follow-up for STI testing, including email and text messaging as reminders of appointments.{{cite journal | vauthors = Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R | title = Active recall to increase HIV and STI testing: a systematic review | journal = Sexually Transmitted Infections | volume = 91 | issue = 5 | pages = 314–23 | date = August 2015 | pmid = 25759476 | doi = 10.1136/sextrans-2014-051930 | doi-access = free | postscript = : Access provided by the University of Pittsburgh Library System }}

Evidence from randomized controlled trials for screening pregnant women who have no symptoms of infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of preterm birth.{{cite journal | vauthors = Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, Ernest JM, Heine RP, Wapner RJ, Trout W, Moawad A, Leveno KJ, Miodovnik M, Sibai BM, Van Dorsten JP, Dombrowski MP, O'Sullivan MJ, Varner M, Langer O, McNellis D, Roberts JM | display-authors = 6 | title = Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection | journal = The New England Journal of Medicine | volume = 345 | issue = 7 | pages = 487–93 | date = August 2001 | pmid = 11519502 | doi = 10.1056/NEJMoa003329 | doi-access = free }}{{Cite journal|title = Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation|journal = American Journal of Obstetrics and Gynecology|pages = 157–167|volume = 173|issue = 1|doi = 10.1016/0002-9378(95)90184-1|first1 = James A.|last1 = McGregor|first2 = Janice I.|last2 = French|first3 = Ruth|last3 = Parker|first4 = Deborah|last4 = Draper|first5 = Elisa|last5 = Patterson|first6 = Ward|last6 = Jones|first7 = Kyja|last7 = Thorsgard|first8 = John|last8 = McFee|year=1995|pmid = 7631673}} Further studies are needed to verify this result and determine the best method of screening. In the U.S., screening of pregnant women without symptoms is recommended only for those with HIV, as Trichomonas infection is associated with an increased risk of transmitting HIV to the fetus.

Treatment for both pregnant and non-pregnant women is usually with metronidazole,[http://www.ashastd.org/learn/learn_vag_trich_tri.cfm#3 Vaginitis/Trichomoniasis :Treatment for trichomoniasis] {{webarchive|url=https://web.archive.org/web/20080401092100/http://www.ashastd.org/learn/learn_vag_trich_tri.cfm |date=2008-04-01 }}, American Social Health Association. Retrieved March 12, 2008. by mouth once.{{cite journal | vauthors = Workowski KA, Bolan GA | title = Sexually transmitted diseases treatment guidelines, 2015 | journal = MMWR. Recommendations and Reports | volume = 64 | issue = RR-03 | pages = 1–137 | date = June 2015 | pmid = 26042815 | pmc = 5885289 }} Caution should be used in pregnancy, especially in the first trimester.{{cite journal | vauthors = Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE | title = Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis | journal = Clinical Microbiology Reviews | volume = 17 | issue = 4 | pages = 783–93, table of contents | date = October 2004 | pmid = 15489348 | pmc = 523556 | doi = 10.1128/CMR.17.4.783-793.2004 }} Sexual partners, even if they have no symptoms, should also be treated.{{cite book | last1= Rob | first1= Lukáš | last2= Martan | first2= Alois | last3= Citterbart | first3= Karel| title = Gynekologie | publisher= Galen | location= Prague | year= 2008 | edition= 2nd | isbn = 978-80-7262-501-7 | page= 136| language=cs|display-authors=etal}} Single oral dose of nitroimidazole is sufficient to kill the parasites.{{cite journal | vauthors = Forna F, Gülmezoglu AM | title = Interventions for treating trichomoniasis in women | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000218 | date = 2003-04-22 | pmid = 12804391 | pmc = 6532670 | doi = 10.1002/14651858.CD000218 | editor-last = Cochrane Infectious Diseases Group }}

For 95–97% of cases, infection is resolved after one dose of metronidazole.{{cite journal | vauthors = Niccolai LM, Kopicko JJ, Kassie A, Petros H, Clark RA, Kissinger P | title = Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women | journal = Sexually Transmitted Diseases | volume = 27 | issue = 5 | pages = 284–8 | date = May 2000 | pmid = 10821602 | doi = 10.1097/00007435-200005000-00009 | s2cid = 37556873 | doi-access = free }} Studies suggest that 4–5% of trichomonas cases are resistant to metronidazole, which may account for some "repeat" cases.{{cite journal | vauthors = Secor WE, Meites E, Starr MC, Workowski KA | title = Neglected parasitic infections in the United States: trichomoniasis | journal = The American Journal of Tropical Medicine and Hygiene | volume = 90 | issue = 5 | pages = 800–804 | date = May 2014 | pmid = 24808247 | pmc = 4015567 | doi = 10.4269/ajtmh.13-0723 }} Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men. Women living with HIV infection have better cure rates if treated for seven days rather than with one dose.{{cite journal | vauthors = Kissinger P, Mena L, Levison J, Clark RA, Gatski M, Henderson H, Schmidt N, Rosenthal SL, Myers L, Martin DH | display-authors = 6 | title = A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women | journal = Journal of Acquired Immune Deficiency Syndromes | volume = 55 | issue = 5 | pages = 565–71 | date = December 2010 | pmid = 21423852 | pmc = 3058179 | doi = 10.1097/qai.0b013e3181eda955 }}

Topical treatments are less effective than oral antibiotics due to Skene's gland and other genitourinary structures acting as reservoirs.{{cite journal | vauthors = Petrin D, Delgaty K, Bhatt R, Garber G | title = Clinical and microbiological aspects of Trichomonas vaginalis | journal = Clinical Microbiology Reviews | volume = 11 | issue = 2 | pages = 300–17 | date = April 1998 | pmid = 9564565 | pmc = 106834 | doi = 10.1128/CMR.11.2.300 }}

Vaginal boric acid can be useful against resistant trichomoniasis.{{cite journal | last=Lærkeholm Müller | first=Matilde | last2=Damsted Petersen | first2=Christina | last3=Saunte | first3=Ditte Marie L. | title=Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti‐Infective Agent: A Systematic Review | journal=Dermatologic Therapy | volume=2024 | issue=1 | date=2024 | issn=1396-0296 | doi=10.1155/2024/2807070 | doi-access=free | page=}}{{cite journal | vauthors = Thorley N, Ross J | title = Intravaginal boric acid: is it an alternative therapeutic option for vaginal trichomoniasis? | journal = Sex Transm Infect | volume = 94 | issue = 8 | pages = 574–577 | date = December 2018 | pmid = 29223972 | doi = 10.1136/sextrans-2017-053343 | url = }}{{cite journal | vauthors = Mittelstaedt R, Kretz A, Levine M, Handa VL, Ghanem KG, Sobel JD, Powell A, Tuddenham S | title = Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review | journal = Sex Transm Dis | volume = 48 | issue = 12 | pages = e241–e247 | date = December 2021 | pmid = 34561373 | pmc = 10100571 | doi = 10.1097/OLQ.0000000000001562 | url = }}

There were about 58 million cases of trichomoniasis in 2013.{{cite journal |vauthors=Vos T | collaboration = GBD Study 2013 Collaborators | title = 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 | journal = Lancet | volume = 386 | issue = 9995 | pages = 743–800 | date = August 2015 | pmid = 26063472 | pmc = 4561509 | doi = 10.1016/s0140-6736(15)60692-4 }} It is more common in females (2.7%) than males (1.4%).{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al | title = 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 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–96 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 | url = http://www.documentation.ird.fr/hor/fdi:010059240 }} 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.Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, and TB. Division of STD Prevention. Trichomoniasis - CDC Fact Sheet. 2012.{{cite journal | vauthors = Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H | display-authors = 6 | title = Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008 | journal = Sexually Transmitted Diseases | volume = 40 | issue = 3 | pages = 187–93 | date = March 2013 | pmid = 23403598 | doi = 10.1097/OLQ.0b013e318286bb53 | s2cid = 25094427 | doi-access = free }} It is estimated that 3% of the general U.S. population is infected,{{cite journal | vauthors = Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L | title = The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004 | journal = Clinical Infectious Diseases | volume = 45 | issue = 10 | pages = 1319–26 | date = November 2007 | pmid = 17968828 | doi = 10.1086/522532 | doi-access = free }} and 7.5–32% of moderate-to-high risk (including incarcerated) populations.{{cite journal | vauthors = Rogers SM, Turner CF, Hobbs M, Miller WC, Tan S, Roman AM, Eggleston E, Villarroel MA, Ganapathi L, Chromy JR, Erbelding E | display-authors = 6 | title = Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults | journal = PLOS ONE | volume = 9 | issue = 3 | pages = e90548 | year = 2014 | pmid = 24626058 | pmc = 3953116 | doi = 10.1371/journal.pone.0090548 | bibcode = 2014PLoSO...990548R | doi-access = free }}{{cite journal | vauthors = Javanbakht M, Stirland A, Stahlman S, Smith LV, Chien M, Torres R, Guerry S | title = Prevalence and factors associated with Trichomonas vaginalis infection among high-risk women in Los Angeles | journal = Sexually Transmitted Diseases | volume = 40 | issue = 10 | pages = 804–7 | date = October 2013 | pmid = 24275733 | pmc = 4188531 | doi = 10.1097/OLQ.0000000000000026 }}

• Trichomonas gallinae is a related pathogen of birds

{{Reflist}}

{{Medical resources

| DiseasesDB = 13334

| ICD11 = {{ICD11|1A92}}

| ICD10 = {{ICD10|A|59||a|50}}

| ICD9 = {{ICD9|131}},{{ICD9|007.3}}

| ICDO =

| OMIM =

| MedlinePlus = 001331

| eMedicineSubj = med

| eMedicineTopic = 2308

| eMedicine_mult = {{eMedicine2|emerg|613}}

| MeshID = D014246

}}

• [https://www.cdc.gov/std/Trichomonas/STDFact-Trichomoniasis.htm Trichomoniasis at Centers for Disease Control and Prevention]
• [https://www.niaid.nih.gov/factsheets/vaginitis.htm Vaginitis/Vaginal infection fact sheet from the National Institute of Allergies and Infections]. The first version of this article was taken from this public domain resource.
• [http://www.emedicinehealth.com/articles/17599-1.asp eMedicine Health Trichomoniasis] {{Webarchive|url=https://web.archive.org/web/20080522111746/http://www.emedicinehealth.com/Articles/17599-1.asp |date=2008-05-22 }}

{{STD/STI}}

{{Protozoal diseases}}

Category:Infections with a predominantly sexual mode of transmission

Category:Parasitic infestations, stings, and bites of the skin

Category:Protozoal diseases

Category:Infectious causes of cancer

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