Trichomoniasis - Causes, Symptoms and Treatments

A protozoal infection of the lower genitourinary tract, trichomoniasis affects about 15% of sexually active females and 10% of sexually active males. This infection, which occurs worldwide, may be acute or chronic in females. The risk of recurrence is minimized when sexual partners are treated concurrently.

Causes of Trichomoniasis:

Trichomonas vaginalis - a tetraflagellated, motile protozoan - causes trichomoniasis in females by infecting the vagina, the urethra and, possibly, the endocervix, bladder, Bartholin's glands, or Skene's glands; in males, it infects the lower urethra and, possibly, the prostate gland, seminal vesicles, or epididymis.

T. vaginalis grows best when the vaginal mucosa is more alkaline than normal (pH about 5.5 to 5.8). Therefore, factors that raise the vaginal pH - use of oral contraceptives, pregnancy, bacterial overgrowth, exudative cervical or vaginal lesions, or frequent douching, which disturbs lactobacilli that normally live in the vagina and maintain acidity-may predispose a woman to trichomoniasis.

Trichomoniasis is usually transmitted by intercourse; less often, by contaminated douche equipment or moist washcloths.

Signs and symptoms of Trichomoniasis:

Approximately 70% of females - including those with chronic infections ­and most males with trichomoniasis are asymptomatic. In females, acute infection may produce variable signs, such as a gray or greenish yellow and possibly profuse and frothy, malodorous vaginal discharge. Its other effects include severe itching, redness, swelling, tenderness, dyspareunia, dysuria, urinary frequency and, occasionally, postcoital spotting, menorrhagia, or dysmenorrhea.

Such symptoms may persist for a week to several months and may be more pronounced just after menstruation or during pregnancy. If trichomoniasis is untreated, symptoms may subside, although T. vaginalis infection persists, possibly associated with an abnormal cytologic smear of the cervix.

In males, trichomoniasis may produce mild to severe transient urethritis, possibly with dysuria and frequency.

Diagnosis of Trichomoniasis:

Direct microscopic examination of vaginal or seminal discharge is decisive when it reveals T. vaginalis, a motile, pearshaped organism. Examination of clear urinc specimens may also reveal T. vaginalls.

Physical examination of symptomatic females shows vaginal erythema; edema; frank excoriation; a frothy, malodorous, greenish yellow vaginal discharge; and, rarely, a thin, gray pseudomembrane over the vagina. Cervical examination demonstrates punctate cervical hemorrhages, giving the cervix a strawberry appearance that is almost pathognomonic for this disorder.

Treatment of Trichomoniasis:

The treatment of choice for trichomoniasis is a single 2-g dose of oral metronidazole given to both sexual partners. Alternative treatment is 500 mg of oral metronidazole given twice daily for 7 days. Oral metronidazole has not been proven safe during the first trimester of pregnancy, but can be considered for use if symptoms are severe. Effective alternatives are not available for patients who are allergic to metronidazole. Sitz baths may be used to help relieve symptoms.

Special considerations and Prevention tips of Trichomoniasis:-

1. Instruct the patient to refrain from douching before being examined for trichomoniasis.

2. Urge abstinence from intercourse until the patient is cured. Refer partners for treatment. Ten the patient to avoid using tampons.

3. Warn the patient to abstain from alcoholic beverages while taking metronidazole because alcohol consumption may provoke a disulfiram-type reaction (confusion, headache, cramps, vomiting, seizures). Also, tell the patient this drug may turn urine dark brown.

4. Caution the patient to avoid over-the­counter douches and vaginal sprays because chronic use can alter vaginal pH.

5. Advise the patient to scrub the bathtub with a disinfecting cleaner before and after sitz baths.

6. Tell the patient she can reduce the risk of genitourinary bacterial growth by wearing loose-fitting, cotton underwear, which allows ventilation; bacteria flourish in a warm, dark, moist environment.