Sexually Transmitted Infections: Trichomonas Vaginalis

Published on 06/06/2015 by admin

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Last modified 06/06/2015

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Chapter 57 Sexually Transmitted Infections: Trichomonas Vaginalis

INTRODUCTION

Description: Infection by the anaerobic flagellate protozoan, Trichomonas vaginalis is most often acquired by sexual contact with an infected person.
Prevalence: Roughly 3 million cases per year, 25% of “vaginal infections.”
Predominant Age: 15 to 50 (may occur at any age).
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: T. vaginalis, an anaerobic flagellate protozoan.
Risk Factors: Multiple sexual partners, vaginal pH that is less acidic. (Blood, semen, or bacterial pathogens increase the risk.) Of asymptomatic partners of women with Trichomonas infections, 30% to 80% have a positive culture. The incubation period for Trichomonas infections is thought to be between 4 and 28 days. Trichomonas has been reported (rarely) in virginal patients, supporting the possibility of nonsexual transmission.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Forty percent may be asymptomatic; a carrier state may exist for many years
• Vulvar itching or burning
• Copious discharge with a rancid odor (generally thin, runny, and yellow–green to gray in color, “frothy” in 25%)
• “Strawberry” punctation of the cervix and upper vagina (15%)
• Dysuria
• Dyspareunia
• Edema or erythema of the vulva

DIAGNOSTIC APPROACH

Differential Diagnosis

• Bacterial vaginitis
• Bacterial vaginosis
• Chlamydial cervicitis
• Gonococcal cervicitis

Associated Conditions: Other sexually transmitted infections (specifically, gonorrhea and chlamydial infection).

Workup and Evaluation

Laboratory: Culture or monoclonal antibody staining may be obtained but are seldom necessary. Evaluation for concomitant sexually transmitted infections should be strongly considered. Detection of Trichomonas by Pap test results in an error rate of 50%. (Alternative tests include OSOM Trichomonas Rapid Test [Genzyme Diagnostics, Cambridge, Massachusetts], an immunochromatographic capillary flow dipstick technology, and the Affirm VP III [Becton Dickinson, San Jose, California], a nucleic acid probe test that evaluates for T. vaginalis, Gardnerella vaginalis, and Candida albicans. These tests have a sensitivity of >83% and a specificity of >97%, although false-positive results are common when prevalence is low.)
Imaging: No imaging indicated.
Special Tests: Vaginal pH 6 to 6.5 or higher.
Diagnostic Procedures:

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