1. Trichomonas vaginalis
4th Lecture

2. Trichomoniasis
Trichomoniasis is a sexually transmitted infection caused by the protozoa Trichomonas vaginalis. It is one of the most common sexually transmitted diseases in the United States. Women with trichomoniasis may experience various symptoms, including a yellow-green vaginal discharge and vulvar irritation, or they may be asymptomatic. Men with trichomoniasis are frequently asymptomatic.

3. Trichomoniasis
The high incidence of trichomoniasis worldwide, its contribution to poor health outcomes, and its co-infection with other sexually transmitted infections make trichomoniasis a compelling public health concern. Notably, T vaginalis infection is believed to increase the risk of HIV transmission. Trichomoniasis is also associated with adverse pregnancy outcomes, infertility, postoperative infections, and cervical neoplasia.

4. Epidemiology
Frequency United States Approximately 8 million new cases of trichomoniasis occur annually. In men, trichomoniasis accounts for 10-21% of urethritis cases not attributable to gonorrheal or chlamydial infection. International Worldwide, the annual incidence of trichomoniasis is about 170 million cases. The incidence of trichomoniasis in Europe is similar to that in the United States. In Africa, the prevalence of trichomoniasis may be much higher.

5. Epidemiology
The infection is highly associated with the presence of other sexually T vaginalis transmitted infections, including gonorrhea, chlamydia, and HIV. In men, complications of untreated trichomoniasis include prostatitis, epididymitis, urethral stricture disease, and infertility. Infertility may result from a decreased sperm motility and viability.

6. Pathophysiology
T vaginalis is approximately the size of a white blood cell (about 10 μm in diameter), although its size may vary with physical conditions. Its flagellum allows it to move around vaginal and urethral tissues. T vaginalis directly damages the epithelium, leading to microulcerations of inhabited tissues, increasing the risk of HIV transmission.

7. Pathophysiology
Symptoms of trichomoniasis typically occur after an incubation period of 4-28 days.
In women, T vaginalis is isolated from the vagina, cervix, urethra and bladder.
In men, the organism is found in the anterior urethra, external genitalia, prostate, epididymis, and semen.

8. Clinical Symptoms
Women Women with trichomoniasis frequently report a frothy yellowish-green vaginal discharge, abnormal vaginal odor, vulvovaginal itching and soreness, dyspareunia (pain during sexual intercourse), and dysuria (pain during urination). Cervicitis due to trichomoniasis is characterized by 2 major signs—purulent discharge in the endocervical canal and easily induced endocervical bleeding. T vaginalis infection is one of the top 3 causes of vaginitis. Vaginitis is usually characterized by vaginal discharge, which may be accompanied by vulvar itching, irritation, and odor.

9. Clinical Symptoms
Men
Trichomoniasis symptoms in men range from none to urethritis complicated by prostatitis. Nongonococcal nonchlamydial urethritis is the most common symptom reported by men with trichomoniasis.
Symptoms of urethritis include discharge, dysuria, and urethral pruritus. The discharge may be purulent to mucoid in character.

10. Structure
All the trichomonads are morphologically similar, having a pear-shaped body μm long, a single anterior nucleus, three to five forward-directed flagella, and a single posteriorly directed flagellum that forms the outer border of an undulating membrane.

11. Trophozoit Only

12. Life Cycle
Trichomonads have the simplest kind of protozoan life cycle, in which the organism occurs only as a trophozoite. Division is by binary fission. Because there is no resistant cyst, transmission from host to host must be relatively direct.

13. Life Cycle

14. Diagnosis
A wet mount preparation of discharge from the patient should be examined microscopically as a first step in diagnosing T vaginalis infection. The presence of typical pear-shaped trophozoites, usually 7 to 23 μm in length, with "bobbling“ motility and, on careful examination, the wavelike movement of the undulating membrane, are usually sufficient to identify T vaginalis. Material that is negative by wet mount examination should be cultured because culturing is a considerably more sensitive, although time-consuming, method of diagnosis.

15. Treatment & Control
Metronidazole is effective in both males and females. Vinegar douche may be useful. Personal hygiene and the use of condoms are helpful.

16. Summary

17. Thank you