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Trichomoniasis

From Wikipedia, the free encyclopedia
"Trich" redirects here. For the hair-pulling disorder, seeTrichotillomania.
Not to be confused withTrichinosis,Trichuriasis,orTrichomonas gallinae.
Trichomoniasis
MicrographshowingTrichomonas vaginalisusingMay-Grünwald staining
SpecialtyGynecologyMicrobiologyInfectious diseases
SymptomsItching in thegenital area,bad smelling thinvaginal discharge,burning with urination, pain with sex[1][2]
Usual onset5 to 28 days after exposure[1]
CausesTrichomonas vaginalis(typicallysexually transmitted)[2][1]
Diagnostic methodFinding the parasite in vaginal fluid,microbial culture,testing for the parasitesDNA[1]
PreventionNot having sex, using condoms, notdouching[1]
MedicationAntibiotics(metronidazoleortinidazole)[1]
Frequency122 million (2015)[3]

Trichomoniasis(trich) is an infectious disease caused by the parasiteTrichomonas vaginalis.[2]About 70% of affected people do not have symptoms when infected.[2]When symptoms occur, they typically begin 5 to 28 days after exposure.[1]Symptoms can include itching in thegenital area,a bad smelling thinvaginal discharge,burning with urination, and pain with sex.[1][2]Having trichomoniasis increases the risk of gettingHIV/AIDS.[1]It may also cause complications duringpregnancy.[1]

Trichomoniasis is asexually transmitted infection(STI) most often spread by vaginal, oral, or anal sex.[1]It can also spread through genital touching (manual sex).[1]People who are infected may spread the disease even when symptoms are not present.[2]Diagnosis is by finding the parasite in thevaginal fluidusing amicroscope,culturingthe vaginal fluid or urine, or testing for the parasite'sDNA.[1]If present, other STIs should be tested for.[1]

Methods of prevention includenot having sex,usingcondoms,notdouching,and being tested for STIs before having sex with a new partner.[1]Although not caused by a bacterium, trichomoniasis can be cured with certainantibiotics(metronidazole,tinidazole,secnidazole).[1]Sexual partners should also be treated.[1]About 20% of people get infected again within three months of treatment.[2]

There were about 122 million new cases of trichomoniasis in 2015.[3]In the United States, about 2 million women are affected.[1]It occurs more often in women than men.[1]Trichomonas vaginaliswas first identified in 1836 byAlfred Donné.[4]It was first recognized as causing this disease in 1916.[5]

Signs and symptoms

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A single trichomonas by phase contrast microscopy

Most people infected withTrichomonas vaginalisdo not have any symptoms and it can be undetected for years.[6]Symptoms include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase duringintercourseandurination.For women there may also be a yellow-green, itchy, frothy, foul-smelling ( "fishy" smell)vaginal discharge.In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure.[7]Sometimes trichomoniasis can be confused withchlamydiabecause the symptoms are similar.[8]

Complications

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Trichomoniasis is linked to several serious complications.

  • Trichomoniasis is associated with increased risk of transmission and infection ofHIV.[9][10]
  • Trichomoniasis may cause a woman to deliver a low-birth-weight orprematureinfant.[9]
  • The role ofTrichomonasinfection in causingcervical canceris unclear, although trichomonas infection may be associated with co-infection with high-risk strains ofHPV.[11]
  • T. vaginalisinfection in males has been found to cause asymptomatic urethritis andprostatitis.In theprostate,it may create chronic inflammation that may eventually lead toprostate cancer.[12][13]

Causes

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Lifecycle ofTrichomonas

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.[14]

The single-celledprotozoanproduces mechanical stress on host cells and then ingests cell fragments after cell death.[15]

Genetic sequence

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A draft sequence of theTrichomonasgenomewas published on January 12, 2007, in the journalScience,confirming that the genome has at least 26,000 genes, a similar number to thehuman genome.An additional approximately 34,000 unconfirmed genes, including thousands that are part of potentially transposable elements, brings the gene content to well over 60,000.[16]

Diagnosis

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There are three main ways to test for trichomoniasis.

  • The first is known as salinemicroscopy.This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope.[17]The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60–70%) often due to an inadequate sample, resulting in false negatives.[18][19]
  • The second diagnostic method isculture,which has historically been the "gold standard" in infectious disease diagnosis.Trichomonas vaginalisculture tests are relatively cheap but sensitivity is still somewhat low (70–89%).[20]
  • The third method includes thenucleic acid amplification tests(NAATs), which are more sensitive.[20]These tests are more costly than microscopy and culture, and are highly sensitive (80–90%).[21]

Prevention

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Use of malecondomsor female condoms may help prevent the spread of trichomoniasis,[22]although careful studies have never been done on how to prevent this infection. Infection with trichomoniasis through water is unlikely becauseTrichomonas vaginalisdies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in diluted urine after 5–6 hours.[23]

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing.[24][25]The Centers for Disease Control and Prevention (CDC) recommends trichomoniasis testing for females with vaginal discharge[26]and can be considered for females at higher risk for infection or of HIV-positiveserostatus.[24]

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women.[24][27]Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis, which can lead to better prevention efforts.[24][27]

A number of strategies have been found to improve follow-up for STI testing, including email and text messaging as reminders of appointments.[28]

Screening

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Evidence from randomized controlled trials for screening pregnant women who have no symptoms of infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk ofpreterm birth.[29][30]Further studies are needed to verify this result and determine the best method of screening. In the U.S., screening of pregnant women without symptoms is recommended only for those with HIV, asTrichomonasinfection is associated with increased risk oftransmitting HIV to the fetus.[31]

Treatment

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Treatment for both pregnant and non-pregnant women is usually withmetronidazole,[32]by mouth once.[31]Caution should be used in pregnancy, especially in the first trimester.[33]Sexual partners, even if they have no symptoms, should also be treated.[23]Single oral dose ofnitroimidazoleis sufficient to kill the parasites.[34]

For 95–97% of cases, infection is resolved after one dose of metronidazole.[26][35]Studies suggest that 4–5% of trichomonas cases are resistant to metronidazole, which may account for some "repeat" cases.[33][9]Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men.[9]Women living withHIVinfection have better cure rates if treated for seven days rather than with one dose.[31][36]

Topical treatments are less effective than oral antibiotics due toSkene's glandand other genitourinary structures acting as a reservoir.[37]

Epidemiology

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There were about 58 million cases of trichomoniasis in 2013.[38]It is more common in females (2.7%) than males (1.4%).[39]It is the most common non-viral STI in the U.S., with an estimated 3.7 million prevalent cases and 1.1 million new cases per year.[40][41]It is estimated that 3% of the general U.S. population is infected,[21][42]and 7.5–32% of moderate-to-high risk (including incarcerated) populations.[43][44]

See also

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References

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  2. ^abcdefg"Trichomoniasis - CDC Fact Sheet".CDC.November 17, 2015.Archivedfrom the original on 19 February 2013.Retrieved21 March2016.
  3. ^abVos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016)."Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015".Lancet.388(10053): 1545–1602.doi:10.1016/S0140-6736(16)31678-6.PMC5055577.PMID27733282.
  4. ^Wiser, Mark (2010).Protozoa and Human Disease.Garland Science. p. 60.ISBN9781136738166.Archivedfrom the original on 2016-04-02.
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  16. ^Scientists crack the genome of the parasite causing trichomoniasisArchived2009-01-04 at theWayback Machine.Physorg. Jan. 12, 2007.
  17. ^Epstein, Aaron; Roy, Subir (2010)."Chapter 50: Vulvovaginitis".In Goodwin, T. Murphy (ed.).Management of Common Problems in Obstetrics and Gynecology(5th ed.).Wiley-Blackwell.p. 228.ISBN978-1405169165.Archivedfrom the original on 2017-02-15.In 80% of cases, the diagnosis of trichomoniasis is confirmed by microscopic examination of saline wet mount, with the observation of motile trichominondas; their shape is "football-like" with moving flagella.
  18. ^Fouts AC, Kraus SJ (February 1980). "Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis".The Journal of Infectious Diseases.141(2): 137–143.doi:10.1093/infdis/141.2.137.PMID6965976.
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