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trichomoniasis

Etiology: - sexually transmitted disease caused by the parasite Trichomonas vaginalis Epidemiology: 1) common cause of vaginitis [5] 2) sexually transmitted disease [5] 3) one of top 5 neglected parasitic infections in the U.S - 3.7 million Americans infected [6] Clinical manifestations: 1) males a) generally asymptomatic b) prostatitis c) urethritis 2) females a) vaginitis 1] inflammation - vulvar pruritus - punctate cervical hemorrhages (strawberry cervix) 2] vaginal discharge - copious, yellowish gray &/or frothy - malodorous b) occasional dysuria c) dyspareunia, postcoital bleeding d) abdominal pain Laboratory: 1) direct wet mount examination of vaginal fluid, prostatic fluid or urine sediment - trichomonads, leukocytes - sensitivity of saline mount is low [12] 2) morphologically resembles Pentatrichomonas hominis, but is larger (up to 23 um) [P. hominis found in feces] 3) undulating membrane extends only 1/2 the length of the body 4) immunoassays commercially available - Trichomonas vaginalis Ag - EIA - immunofluorescence 5) culture 90% sensitive 6) Papanicolaou smears have poor sensitivity 7) Trichomonas vaginalis nucleic acid [11] (gold standard) [12] 8) vaginal fluid pH >= 4.5 Management: 1) metronidazole a) single 2 g dose b) 250 mg TID or 500 mg BID for 7 days better than single dose 2 g dose [13] c) 500 mg QID for 5 days (treatment failure) [4] d) 2-5% of Trichomonas is resistant to metronidazole [3] 2) tinidazole (Tindamax) [4] a) single 2 g dose b) 2 g QD for 5 days (treatment failure) [4] 2) all sexual partners must be treated concurrently 3) 100 mg clotrimazole vaginal suppositories nightly for 2 weeks during pregnancy 4) apparent treatment failures a) re-infection accounts for most cases b) strains of T. vaginalis resistant to metronidazole have been described - treatment of these strains with 1] higher oral doses 2] parenteral doses 3] combination therapy: a] metronidazole b] clotrimazole vaginal suppositories

Related

Trichomonas vaginalis

General

sexually-transmitted disease; sexually-transmitted infection; venereal disease (STD, STI) protozoan infection

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1278
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1205
  3. Prescriber's Letter 11(7):38 2004
  4. Prescriber's Letter 13(9): 2006 Summary Chart of 2006 CDC treatment guidelines for STDs Detail-Document#: 220912 (subscription needed) http://www.prescribersletter.com
  5. Miller M, Liao Y, Gomez AM, Gaydos CA, D'Mellow D. Factors associated with the prevalence and incidence of Trichomonas vaginalis infection among African American women in New York city who use drugs. J Infect Dis. 2008 Feb 15;197(4):503-9. PMID: 18275272 - Van Der Pol B, Kwok C, Pierre-Louis B, Rinaldi A, Salata RA, Chen PL, van de Wijgert J, Mmiro F, Mugerwa R, Chipato T, Morrison CS. Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women. J Infect Dis. 2008 Feb 15;197(4):548-54. PMID: 18275275
  6. Jones SL et al Special Section on Neglected Parasitic Infections. American Journal of Tropical Medicine and Hygiene special section on neglected parasitic infections. http://www.ajtmh.org/content/90/5.toc#SpecialSectiononNeglectedParasiticInfections - Parise ME et al Neglected Parasitic Infections in the United States: Needs and Opportunities. Am J Trop Med Hyg 2014 90(5):783-785 http://www.ajtmh.org/content/90/5/783.full - Centers for Disease Control and Prevention (CDC) Press Release. May 8, 2012 Parasitic Infections also occur in the United States. http://www.cdc.gov/media/releases/2014/p0508-npi.html
  7. Google Health https://health.google.com/health/ref/Trichomoniasis
  8. Trichomoniasis - CDC Fact Sheet http://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm
  9. Trichomoniasis, eMedicine http://www.emedicinehealth.com/trichomoniasis/article_em.htm
  10. Wikipedia: http://en.wikipedia.org/wiki/Trichomoniasis http://en.wikipedia.org/wiki/Trichomoniasis
  11. Workowski KA, Bolan GA (CDC) Sexually Transmitted Diseases Treatment Guidelines, 2015 Recommendations and Reports. MMWR June 5, 2015 / 64(RR3);1-137 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm
  12. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  13. Kissinger P, Muzny CA, Mena LA et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: An open-label, randomised controlled trial. Lancet Infect Dis 2018 Oct 5; PMID: 30297322 - Keizur EM, Klausner JD. The need for new treatment recommendations for trichomoniasis among women. Lancet Infect Dis 2018 Oct 5; PMID: 30297321