Trichomoniasis causes,symptoms and signs complicatins, and treatment

        

       Trichomoniasis and Candidiasis

         Trichomoniasis: A highly transmissible protozoal infection of the genital tract of males and females caused by Trichomonas vaginalis

           Or
    Trichomonas infection is a sexually transmitted infection. It is not normally serious but symptoms can be unpleasant. A course of medicines called antibiotics usually clears the infection.

What is trichomonas and how common is it?

   Trichomonas is a protozoan, which is a tiny germ, similar to bacteria. It can infect your genital area. That is, the vagina and urethra in women, and the urethra and sometimes the prostate gland in men.        This infection is passed on to other people by having sex (intercourse). This infection does not usually go further into your body and so does not tend to be as serious as other sexually transmitted infections (STIs).

     Trichomonas is actually the most common curable STI in the world. However, it is thought that many cases are still not recognised and are not diagnosed.

   What are the symptoms of a trichomonas infection?

                   

Women

       A vaginal discharge is common. This is typically greeny-yellow and may be 'frothy'. The discharge usually has an unpleasant or fishy smell.Your vagina and vulva may be itchy and uncomfortable. The irritation may extend into your groin. Sex may be painful.You may have pain in the lower part of your tummy (abdomen).It may be sore when you pass urine.No symptoms occur in some women. However, you can still pass on the infection even if you have no symptoms.

       In men

 Men

      Discharge from the penis is common.It may be sore when you pass urine.You may pass urine frequently (due to irritation inside the penis).No symptoms occur in most infected men. However, you can still pass on the infection even if you have no symptoms.

Other Clinical Features 
       The incubation period is 5 to 28 days 
      Trichomonas vaginalis infection in women is frequently symptomatic presenting with 
    o Itchy vaginitis 
    o Vulvar and cervical lesions 
    o Lower abdominal pain 
    o Dysuria and dyspareunia 
    o Increased vaginal discharge which is foamy greenish yellow discharge and has what is often described as 
      In most males, the infection is frequently asymptomatic occasionally,   urethritis, epididymitis, and prostatitis can occur

    Differential Diagnosis 
      Neisseria gonorrhoea (in both males and females) 
     Vaginal candidiasis (in females) 
     Gardnerella Vaginalis infection which presents with discharge associated with a ‘musty’ or ‘fishy’ odour.

How does trichomonas infection occur?

Trichomoniasis in female

Trichomonas infection is usually passed on by having sex (intercourse) with an infected person. As no symptoms may occur in both men and women who are infected, you can pass on the infection without realising it.

       It is highly transmissible; susceptibility is general for both male and female like. 
        The parasite thrives(nawili,stawi) in acidic environment (pH 4) as found in the vagina of adult women during the reproductive years. 
        The period of communicability spans from months to years if left untreated. 
        Susceptibility is general for both males and females, though more common in females. 
         No protective immunity occurs in an individual infected with Trichomonia

What are the possible complications with trichomonas infection?

      Pregnancy. If you have untreated trichomonas infection during pregnancy, you have an increased risk of having an early labour and a baby with a low birth weight.

     In men, trichomonas infection can, rarely, cause an unpleasant infection of the prostate gland (called prostatitis).

     HIV. If you have untreated trichomonas infection, you have an increased risk of developing HIV infection if you have sex (intercourse) with someone who is infected with HIV.

    How is trichomonas infection diagnosed?

      It is important to obtain the correct diagnosis, as the same symptoms can be caused by a number of different infections:

     A sample (swab) of the discharge from your vagina or penis is sent to the laboratory to be tested. This may be taken by a healthcare professional, or they may show you how to take one yourself.Trichomonas is sometimes seen by chance when a smear test is done in women.A sample of urine from men may also show the infection.

     What is the treatment for trichomonas infection?

     An antibiotic medicine called metronidazole is the common treatment. You and your partner should be given treatment at the same time and you should avoid having sex (intercourse) for at least one week after receiving your treatment.

      Most people with this infection clear with a short course of metronidazole tablets. Treatment is usually straightforward. Read the leaflet that comes with the tablets for a full list of possible side-effects and cautions. However, the main points to note about metronidazole include:

      This is usually given as a tablet twice a day for 5-7 days or a higher dose as a single dose.Some people feel sick, and may be sick (vomit) when they take metronidazole. This is less likely to occur if you take the tablets straight after food.A metallic taste is also a common side-effect

     Do not drink any alcohol while taking metronidazole and for at least 48 hours after stopping treatment. The interaction with alcohol can cause you to be sick and can cause other problems.Breast-feeding: metronidazole can get into breast milk but is not thought to affect breast-fed babies. However, to play safe, the standard seven-day course with the lower dose is preferred so that a baby does not receive a large dose. If it is essential to use the large 2-gram single dose then breast-feeding should be discontinued for 12-24 hours after taking it.

     Tinidazole is an alternative antibiotic medicine that is sometimes used. This can not be taken if you are pregnant. Breast-feeding should be avoided when taking tinidazole and also for three days after stopping it.

Does my sexual partner need treating?

Yes. Even if they do not have symptoms. You and your partner should be treated at the same time.

Some other points about trichomonas infection

    After you are treated, you may get the infection back if your sexual partner was not treated, or if you have sex with a new partner who has this infection.Other STIs are more common in people with trichomonas infection. You (and your partner) may be advised to be tested for other infections.

     If you suspect that you have trichomonas or any other STI then contact your local genitourinary medicine (GUM) clinic or see your GP. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital or health authority and ask where the nearest clinic is. The FPA and BASHH websites below also include information about where you can find your local clinic.

 

     Trichomoniasis is a very common infection of the female genital tract, affecting about 10% of all women at any one time.
      The amount of discharge is quite variable, and there is little vulvar or vaginal irritation, but the pungent odour is usually the chief complaint.

Management of Trichomoniasis
     Clinical diagnosis is possible especially in areas where laboratory services are not available.
    Whenever laboratory services are available, a fresh drop of vaginal or urethral discharge or high vaginal swab are examined directly (microscopically) for moving protozoa.
     It is very essential to do the examination with a fresh specimen.
      If a patient is complaining of urethral or vaginal discharge it is best to make a gram stain as well to exclude gonococcus and at the same time examine a fresh specimen for Trichomonas can also do a KOH to look for yeast.
    When a laboratory confirmed diagnosis is not possible, it will be necessary to treat the patient for urethral or vaginal discharge using the syndromic approach.

Treatment by dosage shown below

      The treatment of choice is a single dose of metronidazole 2g (ten tables of 200 mg or five tables of 400 mg) swallowed under supervision.
      Alternative dosage is 400mg three times a day for 5 days which gives a higher cure rate, but compliance is poor.
       Tinidazole is also an effective single dose therapy in a dosage of 2g for both men and women, but more expensive than metronidazole and is also
contraindicated in pregnant women.
        It is important to treat both partners even if one partner is asymptomatic.
     • Metronidazole is incompatible with alcohol and must not be given to women in first trimester of pregnancy.
      Women with Trichomonas vaginalis (TV) in pregnancy may be treated as  elaborated above, topically with clotrimazole pessaries to be inserted in the vagina nightly for 6 nights (this may have about 50% cure rate).
       Remember to use the syndromic approach when you cannot confirm the diagnosis by laboratory examination.
       Always counsel the patient regarding safe sex and the use of condoms to avoid future infection with STIs and encourage the patient to bring the sexual partner for treatment.

Prevention and Control Measures
      •> Abstinence
      •> Encourage delaying sexual activity for young people
     •> Sexual and reproductive health education to young people in and out of school
     •>   Faithfulness (have one faithful uninfected partner)
      •> Using condoms correctly and consistently
      •> Correcting myths and misconceptions about condoms
      •> Screening and effective treatment of asymptomatic cases e.g. partners of the patients
      •>Effective treatment of STIs/RTIs

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