I. See also

II. Epidemiology

  1. Accounts for 10% of Vaginitis
  2. Prevalence
    1. General gynecology clinics: 13-23%
    2. Prostitutes: 75%
    3. Increasing Prevalence in asymptomatic women over age 45 years old
  3. Transmission
    1. Sexually Transmitted Disease
    2. Men are asymptomatic in 90% of cases
    3. Often transmitted with Gonorrhea and Chlamydia
    4. Rarely transmitted by moist cloths

III. Etiology

  1. Protozoan infection

IV. Symptoms

  1. Asymptomatic in 25-44% of women
  2. Copious, yellow-green or grayish-green Vaginal Discharge (variably present)
    1. Fishy odor to discharge (variably present)
    2. Frothy discharge (Carbon dioxide bubbles)
      1. Sensitivity: 10%
      2. Specificity: 70%
  3. Vulvar and vaginal Pruritus with irritation and edema
  4. Dysuria (20%)

V. Signs

  1. Vulvar edema and erythema
  2. Tender vaginal or vulvar Ulcerations
  3. Strawberry Cervix (2-3% of cases)
    1. Punctate Hemorrhages or Petechiae
    2. Telangiectasia

VI. Lab

  1. Vaginal pH > 5.0
  2. KOH Preparation
    1. Sniff Test positive
      1. Fishy odor to discharge when KOH added (often negative)
  3. Wet preparation (from vaginal vault, not endocervix)
    1. Read slide immediately
      1. Motility wanes quickly, over minutes
      2. Trichomonad shape morphs from pear-shaped to round with slide drying
    2. Motile pear shaped Trichomonads with flagella exiting from tapering end (70%)
      1. Twice the size of White Blood Cells (WBC)
      2. GynVaginitisTrichomonas.jpg
    3. Efficacy
      1. Test Sensitivity: 60-70%
  4. Specific diagnostic tests (available as point-of-care clinic based tests)
    1. Osom Trichomonas Rapid Test
    2. BD Affirm VPIII Microbial Identification Test
    3. Efficacy
      1. Test Sensitivity: 83%
      2. Test Specificity: >97% (false positives are a concern in regions of low Prevalence)
  5. Other testing
    1. Gram Stain
      1. White Blood Cells over 10 per high powered field
    2. Culture of Trichomonas vaginalis
      1. Grown on modified Diamond media

VIII. Management

  1. General
    1. Treat Sexual Partner also
      1. Metronidazole 500 mg orally twice daily for 7 days is most effective for male partners
    2. Avoid treatment in first trimester of pregnancy
    3. Avoid intravaginal preparations of Metronidazole or Tinidazole due to low cure rates
  2. Non-Pregnant, Non-Lactating Patient
    1. Metronidazole (Flagyl) 2 g orally for 1 dose (preferred) or
    2. Metronidazole (Flagyl) 250 mg PO three times daily for 7 days or
    3. Metronidazole (Flagyl) 500 mg PO twice daily for 7 days or
    4. Tinidazole (Tindamax) 2 grams orally for 1 dose
      1. Teratogenic, Category D (do not use if any risk of pregnancy)
  3. Pregnant (after first trimester, and preferred after 37 weeks)
    1. Metronidazole (Flagyl) 2 g PO for 1 dose ($5) or
    2. Metronidazole (Flagyl) 500 mg PO bid for 7 days
  4. Lactation
    1. Metronidazole (Flagyl) 2 grams PO for 1 dose
    2. Discontinue Lactation for 24 hours after dose
  5. Persistent or Recurrent Cases
    1. Retreat both the partner and the patient
    2. Metronidazole 500 mg PO bid for 14 days
    3. Metronidazole 2g PO qd for 3 days
    4. Metronidazole gel 5g PV bid for 5 days ($30)
    5. Povidone-Iodine Suppository PV bid for 14 days ($60)
    6. Clotrimazole 100 mg vag tab PV qhs for 7 days ($14)
    7. Tinidazole 2 g orally daily for 5 days
      1. Teratogenic, Category D (do not use if any risk of pregnancy)
    8. Paromomycin (Humatin) 5g intravaginally qd x14 days
      1. Higher rate of Vulvitis and local Ulceration

Images: Related links to external sites (from Google)

Ontology: Trichomonas Infections (C0040921)

Definition (MEDLINEPLUS)

Trichomoniasis is a sexually transmitted disease caused by a parasite. It affects both women and men, but symptoms are more common in women. Symptoms in women include a green or yellow discharge from the vagina, itching in or near the vagina and discomfort with urination. Most men with trichomoniasis don't have any symptoms, but it can cause irritation inside the penis.

You can cure trichomoniasis with antibiotics. In men, the infection usually goes away on its own without causing symptoms. But an infected man can continue to infect or reinfect a woman until he gets treated. So it's important that both partners get treated at the same time. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading trichomoniasis.

Centers for Disease Control and Prevention

Definition (MSH) Infections in birds and mammals produced by various species of Trichomonas.
Concepts Disease or Syndrome (T047)
MSH D014245
ICD9 131.9, 131
ICD10 A59 , A59.9
SnomedCT 187364002, 187206001, 56335008, 105648001
English Infections, Trichomonas, Infection, Trichomonas, TRICHOMONIASIS, DISEASES DUE TO TRICHOMONADIDAE, Infection by Trichomonas, NOS, TRICHOMONAL INFECTION, Trichomonas NOS, Trichomoniasis, unspecified, [X]Trichomoniasis, unspecified, INFECT TRICHOMONAS, TRICHOMONAS INFECT, Trichomonas Infections, trichomoniasis (diagnosis), E-531 DISEASES DUE TO TRICHOMONADIDAE, trichomoniasis, Trichomonas infections, [X]Trichomoniasis, unspecified (disorder), Trichomoniasis NOS, Trichomonas NOS (disorder), Trichomonas Infections [Disease/Finding], trichomonosis, trichomona, trichomonas infection, trichomoniasi, trichomonas, Trichomoniasis, Trichomonosis, Disease due to Trichomonadidae (disorder), Disease due to Trichomonadidae, Infection by Trichomonas (disorder), Infection by Trichomonas, Trichomonas; infection, infection; Trichomonas, Trichomonas Infection
Italian Infezioni da trichomonas, Tricomoniasi, Tricomoniasi NAS, Infezioni da Trichomonas
Dutch trichomoniasis, niet-gespecificeerd, Trichomonas; infectie, infectie; Trichomonas, Trichomoniasis, niet gespecificeerd, Trichomonasinfecties, trichomoniasis, Trichomoniasis
French Trichomonase, non précisée, Infections à Trichomonas, Trichomonase, Trichomoniase
German Trichomoniasis, unspezifisch, Trichomoniasis, nicht naeher bezeichnet, Trichomonen-Infektionen, Trichomonadeninfektionen, Trichomoniasis
Portuguese Tricomoníase NE, Infecções por Tricomonas, Infecções a tricomonas, Tricomoníase
Spanish Tricomoniasis no especificada, [X]tricomoniasis, no especificada (trastorno), [X]tricomoniasis, no especificada, Infecciones por Tricomonas, Trichomonas, SAI (trastorno), Trichomonas, SAI, enfermedad por Trichomonadidae (trastorno), enfermedad por Trichomonadidae, infección por Trichomonas (trastorno), infección por Trichomonas, tricomoniasis, tricomonosis, Infecciones por tricomonas, Tricomoniasis
Japanese トリコモナス感染, トリコモナス症、詳細不明, トリコモナスカンセン, トリコモナスショウ, トリコモナスショウショウサイフメイ, トリコモナス感染症, トリコモナス症
Swedish Trichomonasinfektioner
Czech Trichomonas - infekce, Trichomonádové infekce, Trichomoniáza, Trichomoniáza, blíže neurčená
Finnish Trikomoniaasit
Russian TRIKHOMONADNYE INFEKTSII, ТРИХОМОНАДНЫЕ ИНФЕКЦИИ
Korean 편모충증, 상세불명의 편모충증
Polish Trichomoniaza, Rzęsistkowica, Trychomonadoza
Hungarian Trichomonas fertőzések, trichomoniasis, trichomoniasis, nem meghatározott

Ontology: Trichomonas Vaginitis (C0040923)

Definition (MSH) Inflammation of the vagina, marked by a purulent discharge. This disease is caused by the protozoan TRICHOMONAS VAGINALIS.
Concepts Disease or Syndrome (T047)
MSH D014247
SnomedCT 500000, 276877003, 187202004, 187201006, 266165009
English Trichomoniasis, vaginal, Trichomonas Vaginitides, Vaginitides, Trichomonas, Vaginitis, Trichomonas, Trichomonal vulvovaginitis, TRICHOMONAS VAGINALIS INFECTION, FEMALE, Trichomonal Vaginitis, VAGINITIS TRICHOMONAL, trichomonas vaginitis, Leukorrhea - vag.-trichomonal, Leukorrhea vaginalis - trichomonal, Leukorrhoea vaginalis - trichomonal, Trichomonal leukorrhea, Trichomonal leukorrhoea, trichomonas vaginalis vaginitis, Trichomonal vaginitis (diagnosis), Vaginitis trichomonal, VAGINITIS TRICHOMONAS, Trichomonas Vaginitis [Disease/Finding], Trichomonas Vaginitis, trichomonas vaginities, trichomoniasis vaginal, vaginitis trichomonas, Vaginitis;trichomonal, vaginal trichomoniasis, Trichomonal fluor vaginalis, Trichomonal leukorrhea vaginalis, Trichomonal vaginitis, Vaginal trichomoniasis, Trichomonal leukorrhoea vaginalis, Trichomonal vaginitis (disorder), Vaginal trichomoniasis (disorder), trichomonal vaginitis
French Vaginite trichomonale, Vaginite à Trichomonas
German Vaginitis durch Trichomonen, Trichomonaden-Vaginitis, Trichomonadenvaginitis, Trichomonas-Vaginitis, Trichomonas-Kolpitis, Trichomonadenkolpitis, Trichomonaden-Kolpitis, Vaginitis, Trichomonas-
Italian Vaginite da trichomonas, Vaginite da Trichomonas
Portuguese Vaginite a tricomonas, Vaginite por Trichomonas
Spanish Vaginitis por tricomonas, Trichomonal leukorrhea, Leukorrhoea vaginalis - trichomonal, Leukorrhea vaginalis - trichomonal, Trichomonal vaginitis, Trichomonal leukorrhoea, leucorrea vaginal por tricomonas, tricomoniasis vaginal (trastorno), tricomoniasis vaginal, vaginitis por tricomonas, vaginitis tricomoniásica (trastorno), vaginitis tricomoniásica, Tricomoniasis Vaginal, Vaginitis por Trichomonas
Japanese トリコモナス性腟炎, トリコモナスセイチツエン
Swedish Trichomonas-vaginit
Czech trichomonádová vaginitida, Trichomonádová vaginitida
Finnish Trikomonasvaginiitti
Russian TRIKHOMONADNYI VAGINIT, ТРИХОМОНАДНЫЙ ВАГИНИТ
Polish Rzęsistkowica pochwy
Hungarian Vaginitis, trichomonas okozta, Trichomonas vaginitis
Dutch Trichomonas-vaginitis, Vaginitis, trichomonas-