Trichomoniasis Vaginalis

Related Subjects: |Trichomoniasis Vaginalis |Gardnerella vaginalis |Chlamydia trachomatis

About

• Trichomoniasis is caused by a protozoan parasite called Trichomonas vaginalis .
• It is a sexually transmitted infection (STI) affecting the urogenital tract.
• In women, it primarily affects the vagina , while in men, it often affects the urethra .
• Up to 70% of infected individuals are asymptomatic, making it easy to spread without knowing.
• More common in women than men, and can increase susceptibility to other STIs, including HIV.

Aetiology

• Transmitted through sexual contact, including vaginal intercourse and genital-to-genital contact .
• The parasite can survive for a short period in moist environments outside the body, but transmission through contaminated objects is rare .
• Risk factors include multiple sexual partners, history of other STIs, and lack of barrier contraception use.

Clinical Features

• In Men:
  • Itching or irritation inside the penis.
  • Burning sensation after urination or ejaculation.
  • Clear, white, or yellowish penile discharge.
  • In most cases, men remain asymptomatic but can still spread the infection.
• In Women:
  • Itching, burning, redness, or soreness of the vulva or vagina.
  • Discomfort or pain during urination (dysuria).
  • Vaginal discharge : May be thin or frothy, clear, white, yellowish, or greenish with a characteristic fishy odour.
  • Pain during sexual intercourse (dyspareunia).
  • Symptoms can persist and worsen if untreated, lasting for months or even years.

🔬 About

• 🦠 Trichomoniasis is caused by a protozoan parasite called Trichomonas vaginalis.
• ❤️‍🔥 It is a sexually transmitted infection (STI) affecting the urogenital tract.
• 👩 In women, it primarily affects the vagina, while 👨 in men, it often affects the urethra.
• 😶 Up to 70% of infected individuals are asymptomatic → easy to spread unknowingly.
• 📈 More common in women than men, and increases susceptibility to other STIs (including HIV).

🧬 Aetiology

• 🤝 Transmitted via vaginal intercourse and genital-to-genital contact.
• 💧 Parasite can survive briefly in moist environments outside the body, but fomite spread is rare.
• ⚠️ Risk factors: multiple partners, previous STIs, no barrier contraception.

🩺 Clinical Features

• 👨 In Men:
  • Itching or irritation inside penis.
  • 🔥 Burning sensation after urination or ejaculation.
  • 💧 Clear/white/yellow penile discharge.
  • 😶 Often asymptomatic but still infectious.
• 👩 In Women:
  • 🔥 Itching, burning, redness, or soreness of vulva/vagina.
  • 🚽 Dysuria (painful urination).
  • 💨 Vaginal discharge: frothy, greenish-yellow, often with a fishy odour.
  • ❤️‍🩹 Dyspareunia (painful intercourse).
  • ⏳ Untreated symptoms can persist for months–years.

🔎 Investigations

• 🧪 Screen for other STIs (HIV, gonorrhoea, chlamydia).
• 🔬 Wet mount microscopy: motile trichomonads in discharge.
• 🧬 NAAT (swab or urine): highly sensitive & diagnostic.
• 🏥 Refer to GUM clinic for full screening & partner notification.

💊 Management

• 👩‍❤️‍👨 Treat partners simultaneously → prevents reinfection.
• First-line:
  • 💊 Metronidazole 400 mg BD for 5–7 days OR 2 g stat dose.
  • 🤰 In pregnancy: avoid single high dose → use divided regimen (specialist advice).
• Alternative: 🌙 Clotrimazole pessary (symptom relief only, not curative).
• 🚫 Avoid alcohol with metronidazole → risk of severe disulfiram-like reaction.
• ❌ Abstain from sex until both partners have completed treatment & symptoms resolved.

⚠️ Complications

• 👩 Untreated → risk of PID and infertility.
• 🧩 Increased risk of HIV and other STI transmission.
• 🤰 Pregnancy: risk of preterm delivery & low birth weight.

🛡️ Prevention

• 🧍‍♂️🧍‍♀️ Consistent condom use reduces (but doesn’t eliminate) risk.
• 🔁 Regular STI screening for high-risk individuals.
• 📢 Educate about partner notification & treatment.

📚 References

• CDC - Trichomoniasis
• WHO - Trichomoniasis Fact Sheet
• NICE Guidelines on STIs