Trichomoniasis

What are the clinical features for males?

>75% of cases are asymptomatic and transient (spontaneous resolution within 10 days) Symptoms: Clear or mucopurulent urethral discharge Dysuria Burning or pruritus in the penis after sexual intercourse

What are CDC screening recommendations?

All HIV-infected women annually and at the initial prenatal visits All women with new or multiple partners Women with a history of sexually transmitted infections Screening for men is not recommended NON-REPORTABLE infection

What are the possible complications in pregnant women?

Associated with adverse obstetric outcomes: Premature rupture of the membranes Preterm delivery Delivery of a low-birth weight infant

What is the causative agent for Trichomoniasis?

Caused by Trichomonas vaginalis: Flagellated protozoan Infects the squamous epithelium in the urogenital tract

What is the recommendation of sexual partners?

Concurrent treatment of sexual partners Single-dose regimen to maximize compliance Abstain from intercourse for at least 7 days since completing the last antibiotic dose

How is trichomoniasis diagnosed?

Elevated vaginal pH >4.5 and increased polymorphonuclear leukocytes Saline wet-mount microscopy: Motile trichomonads on wet mount is diagnostic Nucleic acid amplification tests (NAAT): Accepted gold standard Detect RNA by PCR or reverse transcriptase Women should also be tested for chlamydia and gonorrhea

What are the possible physical exam findings?

Erythema of the vulva and vaginal mucosa Green-yellow, frothy, malodorous discharge Punctate hemorrhages on the vagina and cervix (strawberry cervix)

What is trichomoniasis?

Genitourinary infection Most common nonviral sexually transmitted disease worldwide Acute or chronic infection Coexistence with bacterial vaginosis pathogen is common

What are the possible complications in nonpregnant women?

Increased susceptibility to acquiring HIV or other STDs Untreated infection can progress to urethritis or cystitis Associated with adverse reproductive outcomes: Cervical neoplasia Pelvic inflammatory disease (PID) Infertility

What are the clinical features for females (acute infection)?

May be asymptomatic Acute infection: Purulent, malodorous, thin discharge Burning Pruritus Dysuria Urinary frequency Lower abdominal pain Dyspareunia: painful sexual intercourse Symptoms may be worse during menstuation Postcoital bleeding may also occur

What are the specific treatment regiments for Trichomoniasis?

Metronidazole or tinidazole Only drugs that provide curative therapy Metronidazole is more cost-effective Tinidazole has fewer gastrointestinal side effects Dosing: 500 mg PO BID x 7 days •Higher curative rate 2 g PO once

What is the possible complication to newborns? Men?

Newborns: May contract infection during delivery Men: Associated with prostatitis, epididymitis, infertility, and prostate cancer

What is the recommended treatment during pregnancy?

Preferred treatment metronidazole 500 mg PO BID x 7 days

What are the clinical features for females (chronic infection)?

Signs and symptoms are milder Pruritus and dyspaneuria with scant vaginal secretions