Trichomoniasis (Common STI) | Causes, Symptoms & Complications (Cancer), Diagnosis, Treatment

Summary

This 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

• 🐛 Trichomoniasis is a sexually transmitted infection caused by the parasitic protozoa Trichomonas vaginalis.
• 🔎 It is the most common 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 prevalence is underestimated, with actual cases likely higher than reported figures.
• 💧 Transmission occurs through sexual contact, with the organism residing in various genital secretions.
• 👶 It can also be transmitted vertically from mother to child during birth.
• 🌿 The organism can cause damage to epithelial cells and increase the vaginal pH, leading to a higher likelihood of co-infections.
• 🤕 Symptoms in women may include abnormal vaginal discharge, itching, and pain during intercourse, while men are often asymptomatic.
• 🩺 Diagnosis can be made through physical examination, wet mount microscopy, nucleic acid amplification tests, or molecular tests.
• 💊 Treatment involves metronidazole or tinidazole, with both partners needing treatment to prevent re-infection.
• 🚫 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

00:00

🦠 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.

05:01

🌐 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.

10:03

🩺 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.

Keywords

💡Trichomoniasis

Trichomoniasis is a sexually transmitted infection (STI) caused by the parasitic protozoa Trichomonas vaginalis. It is the most common non-viral STI and is characterized by symptoms such as vaginal discharge and abnormal odor. The video discusses trichomoniasis as the central theme, detailing its transmission, symptoms, diagnosis, and treatment.

💡STI

STI stands for sexually transmitted infection, which is an infection that is primarily spread through sexual activity. In the context of the video, trichomoniasis is an example of an STI, highlighting the importance of discussing its risk factors, contraction, signs, symptoms, diagnosis, and treatment.

💡Protozoa

Protozoa are single-celled organisms with a nucleus, and Trichomonas vaginalis is a type of protozoa that causes trichomoniasis. The video explains that this protozoa is about the size of a white blood cell and has flagella, which are whip-like tails that enable it to move and spread infection.

💡Flagella

Flagella are whip-like tails that protrude from some cells, including bacteria and protozoa, and enable them to move. In the video, it is mentioned that Trichomonas vaginalis has four flagella, which allow it to move around and facilitate the spread of the infection.

💡Risk Factors

Risk factors are conditions or behaviors that increase the likelihood of developing a health condition. The video identifies unprotected sexual activities and having multiple sexual partners as risk factors for contracting trichomoniasis.

💡Pathophysiology

Pathophysiology refers to the functional changes that occur in the body as a result of disease. The video discusses the pathophysiology of trichomoniasis, explaining how Trichomonas vaginalis damages epithelial cells and alters the vaginal pH, leading to infection.

💡Co-infection

Co-infection occurs when an individual is infected with more than one pathogen at the same time. The video mentions that trichomoniasis often occurs as a co-infection with other STIs like chlamydia and gonorrhea, due to the compromised epithelial barrier.

💡Incubation Period

The incubation period is the time between exposure to a disease-causing agent and the onset of symptoms. The video states that the incubation period for trichomoniasis is 4 to 28 days, indicating the delay before symptoms appear.

💡Metronidazole

Metronidazole is an antibiotic medication used to treat various infections, including trichomoniasis. The video describes metronidazole as the primary treatment for trichomoniasis, with a one-time dose or a seven-day course as treatment options.

💡Ping Pong Effect

The 'ping pong effect' refers to the situation where an infection is passed back and forth between sexual partners due to incomplete treatment. The video emphasizes the importance of treating both partners simultaneously to prevent this effect.

💡Empiric Treatment

Empiric treatment is the administration of therapy based on the most likely cause of a condition, rather than confirmed diagnostic tests. The video suggests that clinicians may consider empiric treatment for chlamydia and gonorrhea in patients with trichomoniasis due to their frequent co-occurrence.

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