Trichomoniasis is a common sexually transmitted infection caused by the protozoan Trichomonas vaginalis. It primarily infects the urogenital tract of females and males. Symptoms can range from an acute inflammatory infection with symptoms like abnormal discharge to an asymptomatic infection. Diagnosis is made through nucleic acid amplification tests or visualizing the motile trichomonads on a wet mount sample. Treatment involves oral metronidazole or tinidazole to cure the infection. Prevention focuses on limiting sexual partners, condom use, and treatment of infected individuals to reduce transmission.

1. TRICHOMONIASIS
DR. ELIOBA J. RAIMON
RESIDENT – OBSTETRICS & GYNECOLOGY
MENTOR
PROF. UBARNEL
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2. PRESENTATION OUTLINE
Introduction
Prevalence
Microbiology
Transmission
Clinical features
Diagnosis
Differential diagnosis
Treatment
Prevention
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3. INTRODUCTION
Trichomoniasis is a genitourinary infection with the protozoan
Trichomonas vaginalis.
It is the most common nonviral sexually transmitted infection (STI)
worldwide
Females are affected more often than males.
Trichomoniasis is one of the three common infectious causes of
vaginal complaints among reproductive-aged females, along with
bacterial vaginosis (BV) and candida vulvovaginitis
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4. PREVALENCE
Global estimates in 2020 156 million new Trichomoniasis
infections occurred (WHO)
Use of nucleic acid amplification tests (NAATs) results in higher
prevalence rates compared with wet mount microscopy and
vaginal pH testing
Studies that used NAATs to detect T. vaginalis in US women
reported overall prevalence ranges from 8.7 to 27 percent
A meta analysis of 18 studies including over 37,000 self-reported
women from African countries noted prevalence rates ranging from
2 to nearly 30 percent
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5. MICROBIOLOGY
The organism responsible for Trichomoniasis is the flagellated
protozoan T. vaginalis, which principally infects the squamous
epithelium in the urogenital tract: vagina, urethra, and
paraurethral glands
Other less common sites include the cervix, bladder, Bartholin
glands, and prostate. Positive tests from oral and rectal sites have
also been reported
The parasite is a pear- or round-shaped organism with four
anterior flagella and an undulating membrane that causes the
characteristic motility seen on a diagnostic wet-mount slide of
vaginal sections
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MICROBIOLOGY

7. TRANSMISSION
Humans are the only natural host
Trichomoniasis is sexually transmitted disease
The incubation period is unknown; however, in vitro studies
suggest an incubation period of 4 to 28 days in approximately
50 percent of patients
Coexistence of T. vaginalis and bacterial vaginosis (BV) is
common; coinfection rates ranging from 20 - 60 to 80 percent
have been reported
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8. CLINICAL FEATURES
Trichomoniasis infection ranges from an acute, severe inflammatory disease
to an asymptomatic carrier state.
Acute infection
Symptoms include a purulent, malodorous, thin vaginal discharge
associated with burning, pruritus, dysuria, frequency, lower
abdominal pain, and/or dyspareunia.
However, typical symptoms may occur in only 11 to 17 percent of
those with confirmed infection; thus, providers should have a low
threshold to test for Trichomonas when any vaginal discomfort is present.
Symptoms may be worse during menstruation.
Postcoital bleeding can occur.
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9. CLINICAL FEATURES
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10. Chronic infection
Signs and symptoms of chronic infection are milder
May include pruritus and dyspareunia, with scanty vaginal discharge
Physical examination findings
Physical examination often reveals erythema of the vulva and vaginal
mucosa.
The classically described green-yellow, frothy, malodorous vaginal
discharge occurs in 10 to 30 percent of symptomatic women.
Punctate haemorrhages may be visible on the vaginal mucosa and/or
cervix (i.e., strawberry cervix or colpitis macularis) in only a small
percent of cases
CLINICAL FEATURES
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CLINICAL FEATURES CONT’D

12. CLINICAL CONSEQUENCES
Nonpregnant patient
Untreated T. vaginalis infection
may result in:
Urethritis or cystitis.
Post hysterectomy cuff
cellulitis or abscess.
Pelvic inflammatory disease.
Infertility.
Increased risk of HIV
acquisition and transmission
Acquisition of other STIs
Pregnant patient
T. vaginalis infection during
pregnancy is associated with
adverse obstetric outcomes
including:-
Premature rupture of the
membranes
Preterm delivery
Low birth weight
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13. DIAGNOSIS
The diagnosis of T. vaginalis is based on testing
Positive nucleic acid amplification test (NAAT)
Motile trichomonads on wet mount of vaginal secretions
Positive culture, or positive rapid antigen or nucleic acid
probe test that confirms T. Vaginalis infection
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14. DIFFERENTIAL DIAGNOSIS
Bacterial vaginosis (BV)
Candida vulvovaginitis
Cervical infections
Atrophic vaginitis in hypo estrogenic females
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15. TREATMENT
Treatment is indicated for both symptomatic and asymptomatic patients.
Treatment has limited side effects, is associated with a high cure rate, likely
reduces the prevalence of T. vaginalis carriage in the population, reduces
transmission of the parasite, and reduces the risk of sequelae
DRUGS
Oral metronidazole 500 mg twice daily for seven days (first line)
Tinidazole 2g oral single dose or 500 mg orally twice daily for five days
according to WHO
Secnidazole 2g oral single dose
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16. PREVENTION
The risk of acquiring T. vaginalis infection can be reduced by
correct and consistent use of condoms
Limit your number of sex partners
Be monogamous
Do not douche
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17. REFERENCE
1. Up to date - Trichomoniasis: Clinical manifestations, diagnosis and
treatment, 23 September 2022
2. William gynaecology, 3rd edition
3. Schwebke J, Merriweather A, Massingale S, et al. Screening for
Trichomonas vaginalis in a Large High-Risk Population: Prevalence
Among Men and Women Determined by Nucleic Acid Amplification
Testing. Sex Transm Dis 2018; 45:e23
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