CASE FILE 1 A 25 y/o female patient consulted her doctor complaining of dysuria and foul-smelling vaginal discharge.

She admitted to becoming sexually-active within the recent months. Microscopic examination of her urine sample showed numerous, flagellated, pear-shaped trophozoites. Treatment was promptly given upon receipt of the lab result. 1. What particular parasite infected the patient? Briefly describe this parasite. Aileen: The 25 year old patient who experienced dysuria and foul smelling of vaginal discharge is infected by the parasite Trachomonas vaginalis. Trichomoniasis is the most prevalent nonviral sexually transmitted disease.

Emjay: Infections of these protozoa are usually asymptomatic or mild for both men and women. However, in
women, the most common infection is symptomatic. Infection has been associated with an increased risk of human immunodeficiency syndrome in both sexes.

Reina: Trichomonas vaginalis, a motile, flagellate trophozoite, divide by a binary fission. It is pear-shaped body
7-15 nanometers long, a single nucleus; three to five forward directed flagella and a single posterior flagellum that makes the outer border of an undulating membrane.

Christina: Trichomonads are all anaerobes and contain hydrogenosomes. This organelle is found in very few
other anaerobic eukaryotes and is termed the anerobic mitochondrion. It acts as the generation of ATP.

Marie: T. vaginalis does not have a cyst form, organisms can survive for up to 24 hours in urine, semen, or
even water samples. It has an ability to persist on fomites with a moist surface for 1 to 2 hours.

Chesmar: Infection usually occurs in women during reproductive years, and occurrence before menarche or
after menopause is rare. 14% to 60% of male infections are associated with known infected female partners.

Bianca: The organism grows best at 37C, and specimens in urine should be considered viable for only 30
minutes to avoid false negatives. Live T. vaginalis have been found in swimming pool water, in urine, and semen after up to 6 - 24 hours, and up to 30 - 45 minutes when exposed to air. 2. What is the mode of transmission of this parasite? Aileen: Trichomonas is usually passed from one person to another during sex. The infection can be spread through unprotected vaginal sex and possibly through sharing sex toys if you dont wash them or cover them with a new condom each time they are used.

Emjay:

There is no resistant cyst that is why there is a direct transmission from host to host.

Reina: It is possible for a pregnant woman to pass the infection to her baby at birth. Transmission to newborn infants from infected mothers is observed in 2 - 17% of cases, and can result in urinary tract or vaginal infections.

Christina: You cannot catch trichomonads from oral or anal sex, or from kissing, hugging, sharing cups, plates
or cutlery, toilet seats or towels.

Marie: The parasite is spread through sexual contact. Women can get it by having penis-to-vagina intercourse
with an infected man or vulva-to-vulva contact with an infected woman. Men usually get it only from infected women.

Chesmar Having too many partners and going back and forth between partners may cause this infection. Bianca: Not using condoms when having sex with a new partner or a partner who may have been exposed to
asexually transmitted disease (STD). It is possible for a partner to transmit the trichomonads parasite without having any symptoms of the infection. 3. What other signs and symptoms can you observe on the patient with this parasitic infection?

Aileen: For women:

when having sex.

soreness, inflammation and itching in and around the vagina. This can cause discomfort

Emjay:

In addition to this, a change in vaginal discharge there may be a small amount or a lot, and it may be

thick or thin, or frothy and yellow. You may also notice a strong smell that may be unpleasant.

Reina: Colpitis macularis (strawberry cervix) can sometimes be seen with the aid of a colposcope as a
speckling of hemorrhagic spots on the mucosa.

Christina: Women may also encounter lower abdominal pain when infected with this infection. Marie: Symptomatic men present with a clear or mucopurulent discharge and dysuria Chesmar Men will encounter a discharge from the penis, which may be thin and whitish. Pain, or a burning
sensation, when passing urine can also happen to men.

Bianca: There is an unusual sore or rash around the genital area

4. Give treatment options for this patient. Aileen: Trichomonas vaginalis are usually treated with metronidazole, a 5-nitroimidazole drug derived from the antibiotic azomycin.

Emjay:

Metronidazole treatment is generally efficient in eliminating T. vaginalis infection and has a low risk of

serious side effects.

Reina: Metronidazole be administered orally, with dose regimens of 250 mg three times a day for 7 days, 500
mg twice a day for 7 days, or a single 2-g dose.

Christina: Food and Drug Administration classify metronidazole as a class B risk factor for pregnancy, a
possible but unconfirmed risk to the fetus. Therefore, the drug has been contraindicated in the first trimester and is considered a second line of therapy in the latter stage of pregnancy.

Marie: Metronidazole is secreted in breast milk in small quantities. It is recommended that lactating mothers
be treated with a single 2-g dose of metronidazole, followed by a 24-h interruption in breast feeding to prevent neonatal exposure to the drug.

Chesmar

Common adverse reactions include nausea, vomiting, headache, insomnia, dizziness, drowsiness,

rash, dry mouth, and metallic taste

Bianca: However, gastrointestinal intolerance and other side effects are more common with single large
doses. Studies have shown that metabolism of metronidazole is reduced at high dosages, making this regimen undesirable for elderly and ill patients and those with liver dysfunction that could result in reduced drug clearance