Trichomoniasis
Trichomoniasis: Excerpt from Professional Guide to Diseases (Eighth Edition)
A protozoal infection of the lower genitourinary (GU) 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 sex partners are treated concurrently.
Causes and incidence
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 hormonal 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 commonly, by contaminated douche equipment or moist washcloths. In the United States, incidence is highest in women ages 16 to 35.
Signs and symptoms
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 1 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
CONFIRMING DIAGNOSIS Direct microscopic examination of vaginal or seminal discharge is decisive when it reveals T. vaginalis (a motile, pear-shaped organism) on wet prep. A Papanicolaou test may also detect the organism. Examination of clear urine specimens may also reveal T. vaginalis.
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’s almost pathognomonic for this disorder.
Treatment
The treatment of choice for trichomoniasis is metronidazole given to both sex partners. Oral metronidazole hasn’t been proven safe during the first trimester of pregnancy but can be considered for use if symptoms are severe. In general, treatment during the first trimester should be avoided if possible. Effective alternatives aren’t available for patients who are allergic to metronidazole. Sitz baths may be used to help relieve symptoms.
Special considerations
❑ Instruct the patient to refrain from douching before being examined for trichomoniasis.
❑ Urge abstinence from intercourse until treatment is completed. Refer partners for treatment. Tell the patient to avoid using tampons.
❑ Warn the patient to abstain from alcoholic beverages while taking metronidazole because alcohol consumption may provoke a disulfiram-type reaction (confusion, headache, cramps, vomiting, and seizures). Also, tell her this drug may turn urine dark brown.
❑ Caution the patient to avoid over-the-counter douches and vaginal sprays because chronic use can alter vaginal pH.
❑ Advise the patient to scrub the bathtub with a disinfecting cleaner before and after sitz baths.
❑ Tell the patient she can reduce the risk of GU bacterial growth by wearing loose-fitting, cotton underpants, which allows ventilation; bacteria flourish in a warm, dark, moist environment.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Trichomoniasis
More Medical Textbooks Online about Trichomoniasis
Review other book chapters online related to Trichomoniasis:
Medical Books Excerpts
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Vaginal discharge (Professional Guide to Signs & Symptoms (Fifth Edition))
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