What is trichomoniasis ?

very common sexually transmitted disease (STD)

that is caused by infection with a protozoan
parasite called Trichomonas vaginalis.
Although symptoms of the disease vary, most
women and men who have the parasite cannot
tell they are infected.
 Filum : Protozoa
Subphylum : Sarcomastigophora
Superclass : Mastigophora
Class : Zoomastigophorea
Family : Trichomonadidae
Genus : Trichomonas
Spesies : Trichomonas tenax
Trichomonas hominis
Trichomonas vaginalis

Epidemiology of Trichomoniasis

Trichomoniasis is considered the most

common curable STD.
Based on WHO incidence is over 250
millions casses in the world, making the
most prevalent no virally sexually
transmitted disease agent .
Infection is more common in women than
in men, and older women are more likely
than younger women to have been infected.
Epidemiology of Trichomoniasis
The incidence rate depends on many factors
including :
1. age
2. Sexual activity
3. numbers of sexual partners
4. other STD
5. Puberty
Human is the only natural host of T. vaginalis
transmission
How do people get
trichomoniasis?
The parasite is passed from an infected person to
an uninfected person during sex.
In women, the most commonly infected part of
the body is the lower genital tract (vulva, vagina,
or urethra)
In men, the most commonly infected body part is
the inside of the penis (urethra and prostat).
It is not common for the parasite to infect other
body parts, like the hands, mouth, or anus.
 some people with the infection get symptoms
while others do not, it probably depends on
factors like the persons age and overall health
Infected people without symptoms can still
pass the infection on to others.
 Trichomonas vaginalis
morphology

Human parasite only

World-wide
5% in normal
population
70% among
prostitutes
Only has 1 stage
trophozoit form, has
no cyst form

13
Morphology
Trophozoites of Trichomonas
vaginalis are pyriform and 7-
30 m long.
They have five flagella: four
anteriorly directed flagella
and one posteriorly along the
outer membrane of the
undulating membrane.
The large nucleus is usually
located at the wider, anterior
end and a small karyosome.
What are the signs and symptoms of
trichomoniasis ?
About 70% of infected people do not have any
signs or symptoms.
When trichomoniasis does cause symptoms,
they can range from mild irritation to severe
inflammation. Symptoms can come and go.
Some people with symptoms get them within 5
to 28 days after being infected, but others do
not develop symptoms until much later.
Signs and symptoms
Male Women
Rarely symptomatic Often asymptomatic
Occasionally mild Mild to severe vaginitis in
urethritis and/or heavy infections
prostatitis itching, burning, redness
may feel itching or or soreness of the
genitals, discomfort with
irritation inside the urination
penis, burning after
urination or discharge with an
unusual smell that can be
ejaculation, or some clear, white, yellowish, or
discharge from the greenish.
penis. Growth of the organism
favored by high pH: >5.9
(N=3.5-4.5)
Host Parasite Interaction
At puberty, Estrogen increases vaginal
secretion and Lactobacillus acidophillus (the
bacterial flora of the vagina) promoting the
break down of glycogen lactic acid pH
become 4,5 (acidic) protection from
infection
At the end of menstruation / menopause
turn over of the epithelial cells enhancing
effect on the adhesive ability T. vaginalis to
vaginal epithelial cells T. vaginalis
phagocitize flora bacterial and also produce
proteinase destroy the Lactobaccili
Pathogenesis
Adherence and adhesion by its flagell
Hemolysis ( iron is one of important
nutrient for T. vaginalis by destructing the
erythrocytes)
Proteinases (11 23 different proteinase)
lytic factors of erythrocyte and also
degrade IgA and IgG which present in the
vagina
Cell detaching factor ( CDF ) cytophatyc
effect destruction of the cells
How is trichomoniasis diagnosed?
Fresh vaginal swab sample
examined under the
microscope showing one
trophozoite
There is no cyst in the life
cycle, transmission is via
trophozoite stadium
this method has a sensi tivity
of only approximately 60%
70% and requires immediate
evaluation of wet
preparation slide for optimal
results
 OSOM Trichomonas Rapid Test, an
immunochromatographic capillary flow
dipstick technology, and the Affirm VP III, a
nucleic acid probe test that evaluates for T.
vaginalis, G. vaginalis, and C. albicans.
Each of these tests, which are performed on
vaginal secretions, have a sensitivity of
>83% and a specificity of >97%.
 Culture is another sensitive and highly
specific commercially available method of
diagnosis.
Among women with trichomoniasis is
suspected but not confirmed by microscopy,
vaginal secretions should be cultured for T.
vaginalis.
What are the complications of
trichomoniasis?
Trichomoniasis can increase the risk of
getting or spreading other sexually
transmitted infections.
For example, trichomoniasis can cause
genital inflammation that makes it easier
to get infected with HIV virus, or to pass
the HIV virus on to a sex partner.
How does trichomoniasis affect a
pregnant woman and her baby?
may have early onset of labor, premature
rupture of the membranes surrounding the
baby in the uterus, and uterine infection after
delivery.
The harmful effects of STDs in babies may
include stillbirth (a baby that is born dead), low
birth weight (less than five pounds),
conjunctivitis (eye infection), pneumonia,
neonatal sepsis (infection in the babys blood
stream), neurologic damage, blindness,
deafness, acute hepatitis, meningitis, chronic
liver disease, and cirrhosis.
 Most of these problems can be prevented if
the mother receives routine prenatal care,
which includes screening tests for STDs
starting early in pregnancy and repeated
close to delivery, if necessary.
Other problems can be treated if the
infection is found at birth.
What is the treatment for
trichomoniasis?
Trichomoniasis can be cured with a single
dose of prescription antibiotic medication
(either metronidazole or tinidazole) orally.
It is safe for pregnant women to take this
medication.
Some people who drink alcohol within 24
hours after taking this kind of antibiotic can
have uncomfortable side effects.
 People who have been treated for
trichomoniasis can get it again.
About 1 in 5 people get infected again
within 3 months after treatment.
Treatment
Recommended Regimens
Metronidazole 2 g orally in a single dose OR
Tinidazole 2 g orally in a single dose
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7 days*
* Patients should be advised to avoid consuming alcohol
during treatment with metronidazole or tinidazole.
Abstinence from alcohol use should continue for 24 hours
after completion of metronidazole or 72 hours after
completion of tinidazole.
Pregnant woman
2 g metronidazole in a single dose at any stage of
pregnancy.
Multiple studies and meta-analyses have not
demonstrated an association between
metronidazole use during pregnancy and
teratogenic or mutagenic effects in infants
The safety of tinidazole in pregnant women,
however, has not been well evaluated.
 There is increasing evidence for epidemiologic
and biologic interaction between HIV and T.
vaginalis

HIV and trichomoniasis

a single dose of metronidazole 2 gm orally
Less effective than
500 mg metronidazole twice daily for 7 days
Follow up Trichomoniasis
rescreening for T. vaginalis at 3 months following initial
infection can be considered for sexually active women
with trichomoniasis

treatment failure occurs with metronidazole 2-g single

dose and reinfection is excluded
the patient can be treated with
metronidazole 500 mg orally twice daily for 7 days
patients failing this regimen
tinidazole or metronidazole at 2 g orally for 5 days
should be considered
How can trichomoniasis be
prevented?
Using latex condoms correctly every time you
have sex. However, condoms dont cover
everything, and it is possible to get or spread
this infection even when using a condom.
avoid having sex entirely.
Early treatment of trichomoniasis, especially
with symptoms like unusual discharge, burning
during urination, or a sore in the genital area,
can reduce transmission to one another
TRICHOMONAS HOMINIS
Morphology
Non-pathogenic;
endocommensal.
Found in large
intestine/cecum.
Ingestion of troph in
contaminated water.
Features: Undulating
membrane & free
flagella.
Has 4 anterior flagella
and 1 posterior flagella.
Trichomonas tenax
 Habitat is in the mouth;
sockets of teeth; gums.
Transmitted orally (kissing;
sharing food eating or
drinking utensils).
Associated with peridontal
disease, mucous in mouth,
but it does not cause this.
This is an opportunist if
conditions are right it is
easier for it to infect.
Pyriform, 4 anterior flagel and 1 posterior flagel,
2/3 undulating membran, 1 nuclei
Chilomastix mesnili
 Non-pathogenic; endocommensal.
Trophs and cysts in the life cycle.
Lives in the cecum.
Divides by binary fission.
Water borne parasite infected by
contaminated water.
 Even though they are not pathogenic and
endocommensal, their presence indicates
poor hygiene practices and sanitation.

Because of this need to be able to

distinguish these from pathogenic
organisms.
 TROPHOZOITE
6-24 m long by 3-20
m wide.

4 flagella arise from

kinetosomes at
anterior end; 3
flagella extend
anteriorly, 1 extends
into the cytostome
(flagella are difficult
to see in stained
trophozoites).
 CYST is lemon-
shaped; 6 to 10 m
in diameter.

Contains single
nucleus, cytosome,
and retracted
flagella.