What is Trichomoniasis?
Trichomoniasis is a sexually transmitted disease affecting both men and women. It is caused by a single celled protozoa Trichomonas vaginalis. It is transmitted sexually through penis to vaginal intercourse or vulva to vulva contact with an infected person. Women are often the carriers and may not have any symptoms. Infected men may not have any symptoms or they may have urethritis (inflammation of the urethra). Incubation period is 5-28 days post exposure.
Trichomoniasis has also been associated with an increased risk of HIV transmission from an infected partner.
Clinical presentation of Trichomoniasis
10-15% women and 15-50% of men with Trichomonas vaginalis may not have any symptoms. In women, they present with purulent foul smelling yellow-green vaginal discharge associated with pain on urination or itch around the vulva area.
In pregnancy, Trichomoniasis infection is associated with pre-term delivery, low birth weight ad premature rupture of membranes.
On examination the vagina and cervix appear red, inflamed, excoriated. The cervix is often described as “strawberry cervix” due to the inflammation and ulcers.
In males, usually they will not have any symptoms. Some will present with muco-purulent discharge, painful urination (dysuria) and itch around urethra.
Confirmatory Tests for Trichomoniasis
1.Direct Microscopy: Vaginal secretions on a wet mount with normal saline are observed under microscope for the presence of the protozoa Trichomonas vaginalis. The sensitivity of the test is 60-70%
2.Culture: high vaginal swab/urethra swab can be cultured on Feinberg-Whittington Media. The sensitivity is more than 90%
3.FDA-cleared rapid strip tests: These rapid tests include Affirm VP III nucleic acid probe test and OSOM Trichomonas Rapid Test that can test for Gardnerella Vaginalis, Trichomonas Vaginalis and Candida Albicans. The specificity is > 97% and sensitivity > 83%.
4.Cervical Pap Smear: Trichomonas Vaginalis have been reported on cervical cytology. The sensitivity is about 60-80% however there can be high false positive results of about 30%. If Trichomonas Vaginalis is found, this should be confirmed by direct microscopy or culture of the vaginal secretions.
Treatment of Trichomoniasis
All patients diagnosed with Trichomoniasis should be treated. Treatment can be commenced with oral metronidazole 2 gram single dose or metronidazole 400 mg twice daily for 1 week or oral tinidazole 2 gram single dose. Topical treatments are not effective.
For children, they can be treated with oral metronidazole syrup 15mg per kg thrice a day for a week.
Metronidazole has not been shown to cause any adverse effects when taken during pregnancy and breastfeeding.
If patients have allergy to metronidazole, the alternative will be insertion of Clotrimazole pessaries of 100 mg every night intra-vaginally for 6 days.
Follow up post treatment of Trichomoniasis
For patients with no more symptoms post treatment, no follow up is necessary. However if symptoms persist, they should be re-treated with oral metronidazole 400 mg twice daily for a week. If there is repeated treatment failure, then they should be treated with oral metronidazole 2 gram single dose daily for 3-5 days.
All sexual partners of patients with Trichomoniasis should be strongly encouraged to be screened and treated if positive.