Trichomoniasis
Trichomoniasis
Definition
Trichomoniasis refers to an infection of the genital and urinary tract. It is the most common sexually transmitted disease, affecting about 120 million women worldwide each year.
Description
Trichomoniasis is caused by a protozoan (the smallest, single-celled members of the animal kingdom). Trichomonas vaginalis is almost always passed through sexual contact. Trichomoniasis is primarily an infection
of women's vaginal and urinary tracts. A woman is most susceptible to infection just after having completed her menstrual period. Men may carry the organism unknowingly, since infection in men may cause mild or no symptoms. Men may also experience urethral discharge or persistent urethritis. Trichomoniasis is associated with HIV transmission and may be associated with adverse pregnancy outcomes.
Causes & symptoms
Because trichomoniasis is a sexually transmitted disease, it occurs more often in individuals who have multiple sexual partners. The protozoan is passed to an individual by contact within the body fluids of an infected sexual partner. It often occurs simultaneously with other sexually transmitted diseases, especially gonorrhea .
In women, the symptoms of trichomoniasis include an unpleasant vaginal odor, and a heavy, frothy, yellow discharge from the vagina. The genital area (vulva) is often very itchy, and there is frequently pain with urination or with sexual intercourse. The labia (lips) of the vagina, the vagina itself, and the cervix (the narrowed, lowest segment of the uterus that extends into the upper part of the vagina) will be bright red and irritated. Women may also experience lower abdominal discomfort.
In men, there may be no symptoms at all. Some men notice a small amount of yellowish discharge from the penis, usually first thing in the morning. There may be some mild discomfort while urinating, testicular pain or tenderness, or lower abdominal pain. Some men infected with trichomoniasis experience persistent urethritis.
The use of antibiotics is a contributing factor to recurrent trichomoniasis in some women because antibiotics affect the balance of bacteria in the vagina, allowing such organisms as T. vaginalis to multiply more rapidly.
Diagnosis
Diagnosis is easily made by taking a sample of the discharge from the woman's vagina or from the opening of the man's penis. The sample is put on a slide and viewed under a microscope. The protozoa, which are able to move about, are easily viewed.
Trichomoniasis tends to be underdiagnosed in men because of the relative mildness of symptoms in men and insufficiently sensitive diagnostic tests. The recent introduction of DNA amplification, however, indicates that the incidence of trichomoniasis in men is much higher than was previously thought.
Treatment
Cure of trichomoniasis may be difficult to achieve with alternative treatments. Some practitioners suggest eliminating sweets and carbohydrates from the diet and supplement with antioxidants , including vitamins A, C, and E, and zinc . Naturopaths may recommend treatment with two douches (a wash used inside the vagina), alternating one in the morning and one at bedtime. One douche contains the herbs calendula (Calendula officinalis ), goldenseal (Hydrastis canadensis ), and echinacea (Echinacea spp.); the other douche contains plain yogurt with live acidophilus cultures. The herbal douche helps to kill the protozoa while the yogurt reestablishes healthy flora in the vagina. Tea tree oil is another alternative remedy for trichomoniasis. Acidifying the vagina by douching with boric acid or vinegar may also be useful. Although not a cure, The Gynecological Sourcebook suggests inserting a garlic (Allium sativum ) suppository (a peeled whole clove wrapped in gauze) every 12 hours for symptomatic relief.
Other remedies include vaginal suppositories that include the ingredient acidophilus once a day for three days. An alternative medicine practitioner can recommend the correct mixture. A vaginal douche consisting of grapefruit seed extract may also help relieve symptoms.
Allopathic treatment
The usual treatment is a single large dose of metronidazole (Flagyl) or split doses over the course of a week. Some sources suggest clotrimazole (Gyne-lotrimin, Mycelex) as an alternative treatment showing a lower cure rate. Application of Betadine, a concentrated antiseptic solution, is another recommendation, although Betadine is messy, stains, and should not be used by pregnant women. However, the Centers for Disease Control (CDC) states that there are no effective alternatives to therapy with metronidazole available. Topical treatment with metronidazole is not advised. Individual evaluations are recommended for those who are allergic to metronidazole or who experience treatment-resistant trichomoniasis. Sexual partners of an infected individual must all be treated, to prevent the infection from being passed back and forth. Sexual intercourse should be avoided until all partners are cured.
As of late 2003, the number of cases of metronidazole-resistant trichomoniasis appears to be increasing rapidly. Some success has been reported with the broad-spectrum anti-parasitic drug nitazoxanide, but further research needs to be done. A group of researchers in Thailand is currently investigating the effectiveness of a group of drugs known as bisquaternary quinolinium salt compounds in treating trichomoniasis.
Women who are taking antibiotics for other illnesses should speak to their health care provider about the possibile effects of the medication(s) on the balance of organisms in their vagina.
Expected results
Prognosis is excellent (90–95%) with appropriate treatment of the patient and all sexual partners. Without treatment, the infection can remain for a long time, and can be passed to all sexual partners.
Prevention
All sexually transmitted diseases can be prevented by using adequate protection during sexual intercourse. Effective forms of protection include male and female condoms. Other preventive measures are similar to those for other forms of vaginitis, including wearing loose cotton clothing and not using douches, vaginal deodorants, or sprays.
Resources
BOOKS
Nash, Theodore E., and Peter F. Weller. "Protozoal Intestinal Infections and Trichomoniasis." Harrison's Principles of Internal Medicine, 14th ed. Edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.
Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Vaginitis." New York: Simon & Schuster, 2002.
Plorde, James J. "Introduction to Pathogenic Parasites: Pathogenesis and Chemotherapy of Parasitic Diseases." Sherris Medical Microbiology: An Introduction to Infectious Diseases. Edited by Kenneth J. Ryan. Norwalk, CT: Appleton and Lange, 1994.
Rosenthal, M. Sara. The Gynecological Sourcebook. Los Angeles, Lowell House. 1994.
PERIODICALS
Chavalitshewinkoon-Petmitr, P., M. Ramdja, S. Kajorndechakiat, et al. "In vitro Susceptibility of Trichomonas vaginalis to AT-Specific Minor Groove Binding Drugs" Journal of Antimicrobial Chemotherapy 52 (August 2003): 287–289.
Ching, Susanne, and Phuong H. Nguyen. "Vaginitis." eMedicine, 5 April 2002. <http://emedicine.com/med/topic2358.htm>.
Davis, Annabel. "Trichomonas vaginalis : Signs, Tests, and Treatment." Nursing Times 94 (November 25-December 1, 1998): 58-59.
Dunne, R. L., L. A. Dunn, P. Upcroft, et al. "Drug Resistance in the Sexually Transmitted Protozoan Trichomonas vaginalis." Cell Research 13 (August 2003): 239–249.
Pirotta, M. V., J. M. Gunn, and P. Chondros. "'Not Thrush Again!' Women's Experience of Post-Antibiotic Vulvovaginitis." Medical Journal of Australia 179 (July 7, 2003): 47–49.
Schwebke, J. R., and E. W. Hook, 3rd. "High Rates of Trichomonas vaginalis Among Men Attending a Sexually Transmitted Diseases Clinic: Implications for Screening and Urethritis Management." Journal of Infectious Diseases 188 (August 1, 2003): 465–468.
OTHER
Centers for Disease Control and Prevention (CDC). "Fact Sheet: Trichomonas Infection. <http://www.cdc.gov/ncidod/dpd/parasites/trichomonas/factsht_trichomonas.htm>.
Kathy S. Stolley
Rebecca J. Frey, PhD
Trichomoniasis
Trichomoniasis
Definition
Trichomoniasis refers to an infection of the genital and urinary tract. It is the most common sexually transmitted disease, affecting about 120 million women worldwide each year.
Description
Trichomoniasis is caused by a protozoan (the smallest, single-celled members of the animal kingdom). Trichomonas vaginalis is passed almost 100% of the time through sexual contact. Trichomoniasis is primarily an infection of women's vaginal and urinary tracts. A woman is most susceptible to infection just after having completed her menstrual period. Men may carry the organism unknowingly, since infection in men may cause mild or no symptoms.
Causes and symptoms
Because trichomoniasis is a sexually transmitted disease, it occurs more often in individuals who have multiple sexual partners. The protozoan is passed to an individual by contact within the body fluids of an infected sexual partner. It often occurs simultaneously with other sexually transmitted diseases, especially gonorrhea.
In women, the symptoms of trichomoniasis include an unpleasant vaginal odor, and a heavy, frothy, yellow discharge from the vagina. The genital area (vulva) is often very itchy, and there is frequently pain with urination or with sexual intercourse. The labia (lips) of the vagina, the vagina itself, and the cervix (the narrowed, lowest segment of the uterus which extends into the upper part of the vagina) will be bright red and irritated.
In men, there are usually no symptoms at all. Occasionally, a man will notice a small amount of yellowish discharge from his penis, usually first thing in the morning. There may be some inflammation of the urethra, or urethritis, which produces mild discomfort while urinating.
The use of antibiotics is a contributing factor to recurrent trichomoniasis in some women because antibiotics affect the balance of bacteria in the vagina, allowing such organisms as T. vaginalis to multiply more rapidly.
Diagnosis
Diagnosis is easily made by taking a sample of the discharge from the women's vagina, or from the opening of the man's penis. The sample is put on a slide, and viewed under a microscope. The protozoa, which are able to move about, are easily viewed.
Trichomoniasis tends to be underdiagnosed in men because of the relative mildness of symptoms in men and insufficiently sensitive diagnostic tests. The recent introduction of DNA amplification, however, indicates that the incidence of trichomoniasis in men is much higher than was previously thought.
Treatment
The usual treatment is a single large dose of metronidazole, or split doses over the course of a week. Sexual partners of an infected individual must all be treated, to prevent the infection being passed back and forth.
Women who are taking antibiotics for other illnesses should speak to their health care provider about the possibile effects of the medication(s) on the balance of organisms in their vagina.
As of late 2003, the number of cases of metronidazole-resistant trichomoniasis appears to be increasing rapidly. Some success has been reported with the broad-spectrum anti-parasitic drug nitazoxanide, but further research needs to be done. A group of researchers in Thailand is currently investigating the effectiveness of a group of drugs known as bisquaternary quinolinium salt compounds in treating trichomoniasis.
KEY TERMS
Metronidazole— An anti-infective agent regarded as the best available drug for treating trichomoniasis. It is sold under the trade names Flagyl and MetroGel.
Protozoan— A one-celled organism belonging to the simplest phylum of the animal kingdom. Trichomoniasis is caused by a protozoan.
Urethritis— Inflammation of the urethra, which is the canal that carries urine from the bladder to the outside of the body.
Alternative treatment
Cure of trichomoniasis may be difficult to achieve with alternative treatments. Some practitioners suggest eliminating sweets and carbohydrates from the diet and supplementing with antioxidants, including vitamins A, C, and E, and zinc. Naturopaths may recommend treatment with two douches (a wash used inside the vagina), alternating one in the morning and one at bedtime. One douche contains the herbs calendula (Calendula officinalis ), goldenseal (Hydrastis canadensis ), and echinacea (Echinacea spp.); the other douche contains plain yogurt. The herbal douche helps to kill the protozoa, while the yogurt reestablishes healthy flora in the vagina. Another herbal remedy that is sometimes used is tea tree oil. Acidifying the vagina by douching with boric acid or vinegar may also be useful.
Prognosis
Prognosis is excellent with appropriate treatment of the patient and all sexual partners. Without treatment, the infection can smolder on for a very long time, and can be passed to all sexual partners.
Prevention
All sexually transmitted diseases can be prevented by using adequate protection during sexual intercourse. Effective forms of protection include male and female condoms.
Resources
BOOKS
Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Vaginitis." New York: Simon & Schuster, 2002.
PERIODICALS
Chavalitshewinkoon-Petmitr, P., M. Ramdja, S. Kajorndechakiat, et al. "In vitro Susceptibility of Trichomonas vaginalis to AT-Specific Minor Groove Binding Drugs" Journal of Antimicrobial Chemotherapy 52 (August 2003): 287-289.
Ching, Susanne, and Phuong H. Nguyen. "Vaginitis." eMedicine April 5, 2002. 〈http://emedicine.com/med/topic2358.htm〉.
Dunne, R. L., L. A. Dunn, P. Upcroft, et al. "Drug Resistance in the Sexually Transmitted Protozoan Trichomonas vaginalis." Cell Research 13 (August 2003): 239-249.
Pirotta, M. V., J. M. Gunn, and P. Chondros. "'Not Thrush Again!' Women's Experience of Post-Antibiotic Vulvovaginitis." Medical Journal of Australia 179 (July 7, 2003): 47-49.
Schwebke, J. R., and E. W. Hook, 3rd. "High Rates of Trichomonas vaginalis Among Men Attending a Sexually Transmitted Diseases Clinic: Implications for Screening and Urethritis Management." Journal of Infectious Diseases 188 (August 1, 2003): 465-468.
OTHER
Centers for Disease Control and Prevention (CDC). "Fact Sheet: Trichomonas Infection." 〈http://www.cdc.gov/ncidod/dpd/parasites/trichomonas/factsht_trichomonas.htm〉.
Trichomoniasis
Trichomoniasis
What Are the Signs and Symptoms?
How Do Doctors Diagnose Trichomoniasis?
What Is the Treatment for Trichomoniasis?
Does the Disease Have Complications?
Can Trichomoniasis Be Prevented?
Trichomoniasis (trih-ko-mo-NYE-uh-sis) is a common sexually transmitted disease (STD) that occurs in both women and men.
KEYWORDS
for searching the Internet and other reference sources
Sexually transmitted diseases (STDs)
Trichomonas vaginalis
What Is Trichomoniasis?
Trichomoniasis (also known as “trich”) is an infection caused by the parasite Trichomonas vaginalis (trih-koh-MO-nas vah-jih-NAL-is). It usually affects the urethra* in men and the vagina or urethra in women.
- *urethra
- (yoo-REE-thra) is the tube through which urine passes from the bladder to the outside of the body.
The disease spreads from person to person through sexual contact and infects primarily women between the ages of 16 and 35. It is one of the most common STDs in young sexually active women, and the U.S. Centers for Disease Control and Prevention says that about 2 million new cases occur in women each year in the United States. As with all STDs, people who have had many sexual partners are more likely to contract trichomoniasis.
What Are the Signs and Symptoms?
Women who contract trichomoniasis are more likely to have symptoms than men who become infected, although many people who have trichomoniasis experience no symptoms at all. If a person has symptoms, they usually appear within 6 months of becoming infected. Women often have a strong-smelling yellow-green or gray foamy vaginal discharge and itching in or around the vagina. Often, the discharge has a fishy odor. They may feel pain or burning during sex or urination and, rarely, lower abdominal* pain. Men typically have no symptoms. When they do, they may feel irritation inside the penis and burning after urination or ejaculation*. They may have a discharge from the penis as well.
- *abdominal
- (ab-DAH-mih-nul) refers to the area of the body below the ribs and above the hips that contains the stomach, intestines, and other organs.
- *ejaculation
- (e-jah-kyoo-LAY-shun) is the discharge of semen, a whitish fluid containing sperm, from the penis.
How Do Doctors Diagnose Trichomoniasis?
If a woman has symptoms of the disease, the doctor will perform a pelvic exam* to look for the tell-tale signs of inflammation on the cervix* and inner walls of the vagina. The doctor will take a sample of fluid from the vagina to look at under the microscope for evidence of the parasite. In some instances, Trichomonas infection may be found during a routine Pap smear* or when vaginal fluid is cultured* to diagnose infection caused by other organisms. Most cases of trichomoniasis that cause symptoms can be diagnosed in the doctor’s office by examining the vaginal fluid under a microscope.
- *pelvic exam
- is an internal examination of a woman’s reproductive organs.
- *cervix
- (SIR-viks) is the lower, narrow end of the uterus that opens into the vagina.
- *Pap smear
- is a common diagnostic test used to look for cancerous cells in the tissue of the cervix.
- *cultured
- (KUL-churd) means subjected to a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.
When trichomoniasis is suspected in a man, the doctor may take a sample of fluid from the man’s urethra to confirm the diagnosis. If the doctor diagnoses trichomoniasis in any patient, tests for other STDs likely will be done as well, because it is common for a person to have more than one STD at the same time.
What Is the Treatment for Trichomoniasis?
Trichomoniasis is treated easily with antibiotics. Oral (by mouth) medication given over 1 week usually cures the disease. Doctors recommend that people who are infected not have sex until they have completed treatment, to limit the risk of spreading the infection. Treating all sexual partners of someone who has trichomoniasis, even if they have no symptoms, also is suggested as a way to prevent a new round of infection or the spread of the disease.
Does the Disease Have Complications?
In a pregnant woman, the infection can bring about early rupture of the amniotic sac* and premature delivery*. Trichomoniasis also may increase the risk of becoming infected with human immunodeficiency (ih-myoono-dih-FIH-shen-see) virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), which severely weakens the immune system.
- *amniotic sac
- (am-nee-AH-tik SAK) is the sac formed by the amnion, the thin but tough membrane that lines the outside of the embryo in the uterus and is filled with fluid to cushion and protect the embryo as it grows.
- *premature delivery
- is when a baby is born before it has reached full term.
Can Trichomoniasis Be Prevented?
The risk of trichomonas infection can be lowered or prevented by:
- practicing abstinence (not having sex)
- practicing safe sex by using a male latex condom
- reducing the number of sexual partners
See also
AIDS and HIV Infection
Chlamydial Infections
Gonorrhea
Sexually Transmitted Diseases
Resources
Organization
U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC runs the National STD and AIDS Hotline to answer questions about sexually transmitted diseases and provide referrals to doctors. It also offers information on trichomoniasis on its website.
Telephone 800-311-3435
Hotline 800-227-8922 http://www.cdc.gov
Website
KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including trichomoniasis.
trichomoniasis
1. an infection of the digestive system by the protozoan Trichomonas hominis, causing dysentery.
2. an infection of the vagina due to the protozoan Trichomonas vaginalis, causing inflammation of genital tissues with vaginal discharge. It can be transmitted to males in whom it causes urethral discharge. Treatment with metronidazole is effective.