Trichomoniasis (Common STI) | Causes, Symptoms & Complications (Cancer), Diagnosis, Treatment
Summary
TLDRThis lesson covers trichomoniasis, the most common non-viral sexually transmitted infection caused by the protozoa Trichomonas vaginalis. It discusses risk factors like unprotected sex and multiple partners, signs including vaginal discharge and abnormal odor, and complications such as infertility and increased risk of other STIs. Diagnosis involves physical exams, microscopy, and nucleic acid tests. Treatment is with metronidazole or tinidazole, emphasizing the importance of treating both partners to prevent re-infection.
Takeaways
- đ Trichomoniasis is a sexually transmitted infection caused by the parasitic protozoa Trichomonas vaginalis.
- đ It is the most common non-viral STI and often co-occurs with other STIs like chlamydia and gonorrhea.
- đ« Risk factors include unprotected sex and having multiple sexual partners.
- đ The prevalence is underestimated, with actual cases likely higher than reported figures.
- đ§ Transmission occurs through sexual contact, with the organism residing in various genital secretions.
- đ¶ It can also be transmitted vertically from mother to child during birth.
- đż The organism can cause damage to epithelial cells and increase the vaginal pH, leading to a higher likelihood of co-infections.
- đ€ Symptoms in women may include abnormal vaginal discharge, itching, and pain during intercourse, while men are often asymptomatic.
- đ©ș Diagnosis can be made through physical examination, wet mount microscopy, nucleic acid amplification tests, or molecular tests.
- đ Treatment involves metronidazole or tinidazole, with both partners needing treatment to prevent re-infection.
- đ« Alcohol should be avoided during treatment due to potential disulfiram-like reactions.
Q & A
What is trichomoniasis?
-Trichomoniasis is a sexually transmitted infection (STI) caused by a parasitic protozoa called Trichomonas vaginalis.
How is trichomoniasis transmitted?
-Trichomoniasis is transmitted through sexual contact. The protozoa can move from one individual to another via vaginal, urethral, and prostatic secretions.
What are some risk factors for getting trichomoniasis?
-Risk factors include unprotected sexual activities and having multiple sexual partners.
What is the prevalence of trichomoniasis in the general population?
-The prevalence is estimated to be between 0.5 to 3 percent, but it is likely underreported.
How does Trichomonas vaginalis cause damage to the body?
-Trichomonas vaginalis damages epithelial cells through contact and the release of cytotoxic chemicals, which can compromise the protective epithelial barrier.
What is the incubation period for trichomoniasis symptoms?
-The incubation period for trichomoniasis symptoms is on average 4 to 28 days.
What are common symptoms of trichomoniasis in females?
-Common symptoms include vaginal discharge that may be bloody or purulent, abnormal vaginal odor, dysprunia, vaginal irritation, itching, post-coital bleeding, and lower abdominal pain.
Are there any symptoms in males with trichomoniasis?
-Most male patients are asymptomatic, but rare symptoms include prostatitis, epididymitis, and testicular pain.
What complications can trichomoniasis lead to?
-Complications can include infertility, pregnancy issues, cervical neoplasia, post-operative issues, increased risk of other STIs including HIV, and pelvic inflammatory disease.
How is trichomoniasis diagnosed?
-Diagnosis can be made through physical examination, saline wet mount, nucleic acid amplification tests (PCR), and molecular tests such as trichomonas assays or rapid tests.
What is the treatment for trichomoniasis?
-Treatment involves the use of metronidazole or tinidazole, with both partners being treated simultaneously to prevent reinfection.
Why is it important to treat both partners for trichomoniasis at the same time?
-Treating both partners simultaneously prevents the 'ping pong effect', where the infection can be transmitted back and forth between untreated partners.
What precautions should be taken when taking metronidazole or tinidazole?
-Patients should avoid alcohol consumption during treatment to prevent a disulfiram-like reaction.
Outlines
đŠ Understanding Trichomoniasis
This paragraph introduces trichomoniasis, a common sexually transmitted infection (STI) caused by the protozoan Trichomonas vaginalis. It explains that trichomoniasis is the most prevalent non-viral STI and often co-occurs with other STIs like chlamydia and gonorrhea. Risk factors include unprotected sex and having multiple sexual partners. The infection spreads through sexual contact and can lead to various health complications if left untreated. The transmission process is detailed, highlighting how the organism multiplies and can cause damage to the vaginal and urethral linings, increasing the risk of other infections. The incubation period is noted to be 4 to 28 days, with many female and almost all male patients being asymptomatic.
đ Symptoms and Complications of Trichomoniasis
The second paragraph discusses the symptoms of trichomoniasis, which are more common in females and can include abnormal vaginal discharge that may be bloody, purulent, green, or yellow, as well as a musty or fishy odor. Other symptoms include pain during intercourse, vaginal irritation, itching, post-coital bleeding, and lower abdominal pain. In males, symptoms are rare but can include prostatitis and testicular pain. Newborns can suffer from systemic symptoms including vaginitis, urinary tract infections, and respiratory infections. The paragraph also outlines the potential complications of trichomoniasis, such as infertility, pregnancy issues, cervical neoplasia, post-operative complications, increased risk of other STIs including HIV, pelvic inflammatory disease, and possibly prostate cancer or BPH.
đ©ș Diagnosis and Treatment of Trichomoniasis
The final paragraph covers the diagnosis and treatment of trichomoniasis. It emphasizes the importance of testing for trichomoniasis in all patients presenting with vaginal discharge and the use of physical examination findings like a 'strawberry cervix'. Diagnostic methods include the older saline wet mount method and newer nucleic acid amplification tests (NAATs). The treatment involves the use of metronidazole or tinidazole, with a recommendation for simultaneous treatment of both sexual partners to prevent the 'ping pong' effect of re-infection. The paragraph also advises against alcohol consumption during treatment due to potential disulfiram-like reactions and suggests empiric treatment for chlamydia and gonorrhea due to their frequent co-occurrence. The video concludes with a call to action for viewers to like, subscribe, and watch related lessons on bacterial vaginosis and other STIs.
Mindmap
Keywords
đĄTrichomoniasis
đĄSTI
đĄProtozoa
đĄFlagella
đĄRisk Factors
đĄPathophysiology
đĄCo-infection
đĄIncubation Period
đĄMetronidazole
đĄPing Pong Effect
đĄEmpiric Treatment
Highlights
Trichomoniasis is a sexually transmitted infection caused by the parasitic protozoa Trichomonas vaginalis.
Trichomonas vaginalis is a single-celled organism with four flagella for motility.
It is the most common non-viral STI and often co-infects with other STIs like chlamydia and gonorrhea.
Risk factors include unprotected sexual activities and multiple sexual partners.
Prevalence is underestimated, with actual cases likely higher than reported.
Transmission occurs through sexual contact and can reside in various genital secretions.
Humans are the only host for Trichomonas vaginalis.
Infection can damage the vaginal lining and increase the risk of other STIs.
Trichomonas vaginalis can increase vaginal pH, altering the protective acidic environment.
Vertical transmission from mother to child can occur during birth.
Symptom onset has an incubation period of 4 to 28 days.
About 50% of infected females and almost all males are asymptomatic.
Symptoms can include abnormal vaginal discharge, odor, dyspareunia, and post-coital bleeding.
Complications include infertility, pregnancy issues, and an increased risk of cervical cancer.
Diagnosis can be made through physical examination, wet mount, or nucleic acid amplification tests.
Treatment involves metronidazole or tinidazole, with both partners needing treatment to prevent re-infection.
Alcohol should be avoided during treatment due to a disulfiram-like reaction.
Co-infection with chlamydia or gonorrhea is common, so empiric treatment for these may be considered.
Transcripts
hi everyone we're talking about the
sexually transmitted infection known as
trichomoniasis in this lesson so we're
going to talk about risk factors for
getting it how it is contracted also
talk about the signs and symptoms how
it's diagnosed and how it's treated so
as was just mentioned trichomoniasis is
a sexually transmitted infection or STI
and it is due to an infection with a
parasitic protozoa known as trichomonas
vaginalis
so this is a protozoa it's going to be a
single-celled organism with a nucleus
it's about the size of a white blood
cell and it has four flagella and
flagella are these whip-like tails that
allow it to move around so it allows for
motility of these organisms and these
organisms can spread from Individual to
individual through sexual contact and
cause infection and we'll talk about
this in more detail when we talk about
the pathophysiology in the next slide
now trichomoniasis is one of the most
common STIs and in fact it is the most
common non-viral STI and it commonly
occurs as a co-infection with other STIs
like chlamydia and gonorrhea now the
risk factors for getting trichomonas
vaginalis infections is a variety of
high-risk sexual activities now these
can include unprotected sexual
activities and multiple sexual partners
now the prevalence of this condition is
estimated to be anywhere from 0.5 to 3
percent of the general population some
high-risk groups will have higher
prevalences and even these numbers are
likely under reported numbers so there's
likely more individuals who have
trichomoniasis than the numbers we can
actually see so let's talk about how
trichomonas vaginalis infects
individuals to cause trichomoniasis so
as mentioned before it's through sexual
contact so what will happen is if an
individual is infected they will have
these trichomonas vaginalis organisms
and these organisms like we mentioned
before are motile they can move around
on their own
and they're going to reside in vaginal
secretions
urethral secretions and prostatic
secretions so they can reside in the
prostate as well and they're going to
multiply so if you have a few of them
they're going to multiply and they will
multiply by what we call longitudinal
binary fission and what this means is
that essentially the organism is split
down the middle one organism into two so
this is binary fission
and they can Sprint from these
secretions to other sexual partners this
is how they can spread now some other
information with regards to the
transmission in pathophysiology and the
summary of what we just talked about
includes the following humans are the
only host for trichomonas vaginalis so
they're not going to be found in other
species
as mentioned before they're present in
vaginal secretions of females and
urethral and prostatic secretions of
males and transmission occurs via sexual
intercourse
and what will happen is when an
individual actually contracts this
organism the trichomonas vaginalis will
actually damage epithelial cells via
contact with those cells and release of
cytotoxic chemicals so it can damage the
vaginal lining and some of the parts of
the urethra as well this is why we can
see an increased risk or a higher
likelihood of having a co-infection with
another STI because that protective
epithelial barrier has been compromised
by this organism furthermore this
organism can actually increase the
vaginal pH so it can increase the
vaginal pH above 4.5 meaning that the
vaginal environment has changed normally
the vaginal environment is going to be
more acidic but this organism is going
to decrease the acidity of that
environment allowing itself to increase
in number but also allowing other
bacterial species and other organisms to
multiply as well so that protective
acidic vaginal environment is not going
to be present it's not going to suppress
the growth of other organisms such as
bacterial species and this can increase
the likelihood of other conditions like
bacterial vaginosis and then one last
point I want to mention is that we
talked about this being transmitted by a
sexual intercourse but it can also be
transmitted vertically meaning that it
can be transmitted from one parent to
the other so during delivery during
birth a female can transmit this to
their newborn baby and when an
individual does get this or they can
track this organism it takes about 4 to
28 days on average for patients to start
experiencing symptoms so it can be
delayed with regards to seeing these
symptoms so the incubation period is 4
to 28 days so let's talk about the
clinical features of having this
condition so a couple important points
to make note of here almost 50 percent
of females are going to be asymptomatic
so even if they are infected with this
organism 50 percent of females are not
going to have any signs or symptoms at
all in male patients almost all are
going to be asymptomatic so even if they
have these organisms in their urethra or
their prostate they're not going to
experience symptoms most of the time but
when there are symptoms we can see
symptoms like vaginal discharge this is
going to be the most common symptom this
vaginal discharge may be bloody or
purulent so because those organisms are
actually damaging the epithelial cells
in the vagina they can cause bleeding to
occur and there can be some pus mixed in
with the vaginal discharge as well the
discharge can also be a green color or a
yellow color so often the characteristic
color of vaginal discharge in
trichomoniasis is going to be green we
can also see issues with abnormal
vaginal odor so the odor is often going
to be described as musty and in some
cases it may smell fishy although this
is more likely to be bacterial vaginosis
bacterial vaginosis the vaginal
discharge in bacterial vaginosis is more
likely to be a fishy smell than it would
be in trichomoniasis we can also see
issues with dysprunia this peronia is
going to be pain during intercourse we
can also see issues with Volvo vaginal
irritation and burning vole vaginal
itching post-coital bleeding so bleeding
after intercourse and then in some cases
we may see pain in the lower abdomen
dysuria or cloudy urine so this year is
a burning sensation when urinating and
then in those rare male patients that
experience symptoms they may have
prostatitis which is an inflammation of
the prostate gland we mentioned that
these organisms can reside in the
prostate epididymitis so this is an
inflammation of the epididymis and
testicular pain testicular pain may also
occur in some patients as well although
again these are going to be more rare
and then with regards to newborn
transmission if a newborn baby has
trichomoniasis they often are going to
have other systemic symptoms so they can
not only have vaginitis which is an
inflammation of the vagina but they can
have issues with urinary tract
infections and respiratory infections as
well so this is going to be important in
newborns who have trichomoniasis and not
only those symptoms we just talked about
but trichomoniasis can also cause a
multi attitude of complications
some include infertility so there's a
higher rate of infertility in patients
who are infected with trichomoniasis
there can be pregnancy issues there can
be issues with cervical neoplasia so
these organisms may actually cause
issues with the cells of the cervix
multiplying too much so there can be an
increased risk for cervical cancer
we can also see issues with
post-operative issues so if there's some
operation especially gynecological
operation there can be post-operative
issues if they are infected with
trichomoniasis as mentioned before
there's an increased risk of STIs like
chlamydia and gonorrhea we talked about
that epithelial barrier again because
trichomonas vaginalis can cause damage
to those epithelial cells that
protective barrier is going to be
compromised which is going to increase
the likelihood of other infections as
well and not only chlamydia gonorrhea
but having trichomoniasis can also
increase your risk for getting HIV as
well so this is all going to be related
to those risk factors we talked with
before those high risk sexual activities
and then we can also see increased risk
of pelvic inflammatory disease as well
and as I mentioned before these
organisms can reside in the prostate
gland and there has been some evidence
suggesting that having trichomoniasis
can increase the risk of having prostate
cancer or benign prostatic hyperplasia
or BPH so this is something else I want
to make note of as well let's talk about
how this condition is diagnosed by
clinicians so it's important to test for
this in all patients with vaginal
discharge so if there's any vaginal
discharge it's important to check for
Trichomoniasis so a history of physical
examination is going to be important if
a cervical examination is performed you
may see a strawberry cervix and this
occurs in roughly 40 percent of patients
who have trichomoniasis the older method
of diagnosing trichomoniasis was by
saline wet Mount this is still performed
although some newer methods have come
out that are starting to replace this
but again it still performed it's a
cheaper method of diagnosis but it has a
lower sensitivity so essentially you
look at the vaginal discharge under
microscope and you can essentially see
these trichomonas vaginalis organisms on
the wet Mound and then some other newer
methods of diagnosis includes nucleic
acid amplification tests or pcrs so this
increases the sensitivity quite
substantially and then molecular tests
so there are a wide variety of kits that
can be used to make the diagnosis some
of these are trichomonas assays or
trichomonas rapid tests so there are a
lot of company kits that can be used to
make the diagnosis as well and because
there's such a high rate of
co-occurrence with other STIs it's
important to test for those other STIs
like chlamydia and gonorrhea and it's
also important to test or look for
bacterial vaginosis so as mentioned
before bacterial vaginosis is associated
with trichomoniasis as well and then
there are other tests and findings that
can be employed so with tests may be
performed when looking at the vaginal
discharge so with test is where there is
a drop of Koh or potassium hydroxide
that is placed onto the vaginal
discharge and it will produce a very
strong fishy smell that would be a
positive with test this is less common
to find this in trichomoniasis but it is
a very important finding in bacterial
vaginosis so if you actually have a
positive whiff test it's likely that
this is bacterial vaginosis we can also
see a higher vaginal pH so a vaginal pH
greater than 4.5 and if patients have
pap smears performed these organisms may
actually be seen on the pap smear so
that's also something I want to make
note of as well once a clinician has
made the diagnosis how do they treat it
so this condition may actually be
self-limiting in males but it's still
important to treat because of some of
those complications we talked about
before and if it's not treated it may
remain subclinical meaning that the
symptoms are not as severe they become
more and more mild over time but the
patient is still infected so they can
become subclinical or they may resolve
on their own but again it's important to
treat this condition because of all
those complications we talked about
before
so the treatment of trichomoniasis is
going to be by metronidazole or
tinidazole now it's going to be
important with regards to treatment of
trichomoniasis is that it's going to be
important to treat both Partners
simultaneously so treating both Partners
at the same time so if you would only
treat one partner what can happen is we
can have something called the ping pong
effect so the ping pong effect is
essentially where this infection can
ping-pong or go back and forth between
partners so that's why it's important to
treat partner simultaneously if you were
to treat them delayed if you were to
treat one a little later than the other
what can happen is if you treat one
partner that treated partner can then
have a resolution but then the untreated
partner can spread it back to the
treated partner and then if you were to
treat that other person they will have a
resolution but then you would have
another person that has that infection
again so it can ping pong back and forth
if you don't actually treat it
simultaneously so that's why it's going
to be important and you may be thinking
if a person has this and they have a
resolution this may actually improve
their immunity but that's not the case
either because previous infection does
not provide substantial immunity to
reinfection so each time is going to be
important to treat this with regards to
using metronidazole it's going to either
be a one-time dose of 2 grams or it's
going to be a seven day course of 500
milligrams twice per day now oftentimes
patients are going to have the 2 gram
single dose because it's often easier
for the patient but in some cases some
research suggests that if a patient has
HIV it may be better to actually treat
them with the 500 milligrams twice daily
every day for seven days so that certain
regimen may be better for those patients
and then if metronidazole doesn't work
and if metronidazole doesn't work
tinidazole will be the one that will be
used and when using metronidazole or
tinidazole it's important to avoid
alcohol consumption during the treatment
because of a disulfiram-like reaction so
essentially if you're drinking alcohol
when taking these antibiotics it can
make you sick and it's also important
for clinicians to consider empiric
treatment for chlamydia gonorrhea
because they co-occur so frequently
sometimes impure treatments simply
treating for committee and gonorrhea
with other antibiotics can be important
to Simply remove that chance that they
may actually have chlamydia in gonorrhea
so please check out my lesson on
bacterial vaginosis and also chlamydia
and gonorrhea if you haven't already
please like And subscribe for more
lessons like this one thanks much for
watching and hope see you next time
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