TRICHOMONIASIS

What is trichomoniasis
?

very common sexually transmitted

disease (STD) that is caused by
infection with a protozoan parasite
called Trichomonas vaginalis.
Although symptoms of the disease
vary, most women and men who have
the parasite cannot tell they are
infected.

Classification
Filum

: Protozoa
Subphylum : Sarcomastigophora
Superclass : Mastigophora
Class : Zoomastigophorea
Family : Trichomonadidae
Genus : Trichomonas
Spesies : Trichomonas tenax
Trichomonas hominis
Trichomonas vaginalis

Epidemiology of
Trichomoniasis

Trichomoniasis is considered the most

common curable STD.
Based on WHO incidence is over
250 millions casses in the world,
making the most prevalent
Infection is more common in
women than in men, and older
women are more likely than
younger women to have been
infected.

Epidemiology of
Trichomoniasis

The incidence rate depends on many

factors including :
1. age
2. Sexual activity
3. numbers of sexual partners
4. other STD
5. Puberty
Human is the only natural host of T.
vaginalis transmission

How do people get trichomoniasis?

The parasite is passed from an infected

person to an uninfected person during
sex.
In women, the most commonly infected part of
the body is the lower genital tract (vulva,
vagina, or urethra)
In men, the most commonly infected body part
is the inside of the penis (urethra and
prostat).
It is not common for the parasite to infect other
body parts, like the hands, mouth, or anus.

some people with the infection get

symptoms while others do not, it
probably depends on factors like the
persons age and overall health
Infected people without symptoms
can still pass the infection on to
others.

Trichomonas
Trichomonas vaginalis
vaginalis
morphology
morphology

Human
Human parasite
parasite
only
only
World-wide
World-wide
5%
5% in
in normal
normal
population
population
70%
70% among
among
prostitutes
prostitutes
Only
Only has
has 11 stage
stage

trophozoit
trophozoit
form,
form, has
has no
no
cyst
cyst form
form

13

Morphology

Trophozoites of Trichomonas
vaginalis are pyriform and
7-30 m long.
They have five flagella:
four anteriorly directed
flagella and one
posteriorly along the outer
membrane of the
undulating membrane.
The large nucleus is
usually located at the wider,
anterior end and a small
karyosome.

What are the signs and

symptoms of trichomoniasis ?

About 70% of infected people do not

have any signs or symptoms.
When trichomoniasis does cause
symptoms, they can range from mild
irritation to severe inflammation.
Symptoms can come and go.
Some people with symptoms get
them within 5 to 28 days after being
infected, but others do not develop
symptoms until much later.

Signs and symptoms

Male

Rarely symptomatic
Occasionally mild
urethritis and/or
prostatitis
may feel itching or
irritation inside the
penis, burning after
urination or
ejaculation, or
some discharge
from the penis.

Women

Often asymptomatic
Mild to severe vaginitis in
heavy infections
itching, burning, redness
or soreness of the genitals,
discomfort with urination
discharge with an unusual
smell that can be clear,
white, yellowish, or
greenish.
Growth of the organism
favored by high pH: >5.9
(N=3.5-4.5)

Proportion of asymptomatic
trichomoniasis

symptomatic
73%

Women

77%

asymptomatic

Men

Symptomsincludedpenileorvaginaldischargeoritching,
dysuria,orlowerabdominalpain.

Host Parasite
Interaction

At puberty, Estrogen increases vaginal

secretion and Lactobacillus acidophillus (the
bacterial flora of the vagina) promoting the
break down of glycogen lactic acid pH
become 4,5 (acidic) protection from
infection
At the end of menstruation / menopause
turn over of the epithelial cells enhancing
effect on the adhesive ability T. vaginalis to
vaginal epithelial cells T. vaginalis
phagocitize flora bacterial and also produce
proteinase destroy the Lactobaccili

Pathogenesis

Adherence and adhesion by its flagell

Hemolysis ( iron is one of important
nutrient for T. vaginalis by destructing the
erythrocytes)
Proteinases (11 23 different proteinase)
lytic factors of erythrocyte and also
degrade IgA and IgG which present in the
vagina
Cell detaching factor ( CDF ) cytophatyc
effect destruction of the cells

How is trichomoniasis diagnosed?

Fresh vaginal swab sample

examined under the
microscope showing one
trophozoite
There is no cyst in the life
cycle, transmission is
via trophozoite stadium
this method has a sensi
tivity of only approximately
60%70% and requires
immediate evaluation of
wet preparation slide for
optimal results

OSOM Trichomonas Rapid Test, an

immunochromatographic
capillary
flow dipstick technology, and the
Affirm VP III, a nucleic acid probe test
that evaluates for T. vaginalis, G.
vaginalis, and C. albicans.
Each of these tests, which are
performed on vaginal secretions,
have a sensitivity of >83% and a
specificity of >97%.

Culture is another sensitive and

highly
specific
commercially
available method of diagnosis.
Among women with trichomoniasis
is suspected but not confirmed by
microscopy, vaginal secretions
should be cultured for T.
vaginalis.

What are the complications of trichomoniasis?

Trichomoniasis can increase the

risk of getting or spreading
other sexually transmitted
infections.
For example, trichomoniasis can
cause genital inflammation that
makes it easier to get infected
with HIV virus, or to pass the HIV
virus on to a sex partner.

How does trichomoniasis affect a pregnant woman and her

baby?

may have early onset of labor, premature

rupture of the membranes surrounding the
baby in the uterus, and uterine infection after
delivery.
The harmful effects of STDs in babies may
include stillbirth (a baby that is born dead),
low birth weight (less than five pounds),
conjunctivitis (eye infection), pneumonia,
neonatal sepsis (infection in the babys blood
stream),
neurologic
damage,
blindness,
deafness, acute hepatitis, meningitis, chronic
liver disease, and cirrhosis.

Most of these problems can be

prevented if the mother receives
routine
prenatal
care,
which
includes screening tests for
STDs starting early in pregnancy
and repeated close to delivery, if
necessary.
Other problems can be treated if
the infection is found at birth.

What is the treatment for trichomoniasis?

Trichomoniasis can be cured with a

single dose of prescription antibiotic
medication (either metronidazole or
tinidazole) orally.
It is safe for pregnant women to take
this medication.
Some people who drink alcohol within 24
hours after taking this kind of antibiotic
can have uncomfortable side effects.

People who have been treated for

trichomoniasis can get it again.
About 1 in 5 people get infected
again within 3 months after
treatment.
Metronidazole obstruct nucleic
acid syntesis
Tinidazole bind to DNA, causing
DNA damage and leading to cell
death

Treatment
Recommended Regimens
Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single dose
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7 days*
* Patients should be advised to avoid consuming
alcohol during treatment with metronidazole or
tinidazole. Abstinence from alcohol use should
continue for 24 hours after completion of
metronidazole or 72 hours after completion of
tinidazole.

Pregnant woman
2 g metronidazole in a single dose at any
stage of pregnancy.
Multiple studies and meta-analyses have
not demonstrated an association between
metronidazole use during pregnancy and
teratogenic or mutagenic effects in infants
The safety of tinidazole in pregnant women,
however, has not been well evaluated.

There is increasing evidence for

epidemiologic and biologic interaction
between HIV and T. vaginalis
HIV and trichomoniasis
a single dose of metronidazole 2 gr
orally
Less effective than
500 mg metronidazole twice daily for
7 days

Follow up Trichomoniasis

rescreening for T. vaginalis at 3 months

following initial infection can be considered
for
sexually
active
women
with
trichomoniasis
treatment failure occurs with
metronidazole 2-g single dose and
reinfection is excluded
the patient can be treated with
metronidazole 500 mg orally twice daily for 7
days
patients failing this regimen
tinidazole or metronidazole at 2 g orally for 5
days should be considered

How can trichomoniasis be prevented?

Using latex condoms correctly every time

you have sex. However, condoms dont
cover everything, and it is possible to get
or spread this infection even when using
a condom.
avoid having sex entirely.
Early
treatment
of
trichomoniasis,
especially with symptoms like unusual
discharge, burning during urination, or a
sore in the genital area, can reduce
transmission to one another

TRICHOMONAS
HOMINIS
Or
Pentatrichomonas
hominis

Morphology
Non-pathogenic;

endocommensal.
Found in large
intestine/cecum.
Ingestion of troph in
contaminated water.
Features: Undulating
membrane & free
flagella.
Has 4 anterior
flagella and 1
posterior flagella.

Trichomonas tenax

 Habitat is in the mouth;

sockets of teeth; gums.

Transmitted orally
(kissing; sharing food
eating or drinking
utensils).
Associated with
peridontal disease,
mucous in mouth, but it
does not cause this.
This is an opportunist
if conditions are
right it is easier for it
to infect.

Pyriform, 4 anterior flagel and 1 posterior

flagel, 2/3 undulating membran, 1 nuclei

Chilomastix mesnili

Non-pathogenic;

endocommensal.
Trophs and cysts in the life
cycle.
Lives in the cecum.
Divides by binary fission.
Water borne parasite
infected by contaminated
water.

Even though they are not

pathogenic and
endocommensal, their
presence indicates poor
hygiene practices and
sanitation.

Because of this need to be able

to distinguish these from
pathogenic organisms.

TROPHOZOITE
6-24 m long by
20 m wide.

3-

4 flagella arise from

kinetosomes at
anterior end; 3
flagella extend
anteriorly, 1 extends
into the cytostome
(flagella are difficult
to see in stained
trophozoites).

Nature did not have

CYST is lemonrewards
shaped;
6 to and punishments.
10Only
m consequences
in
are present..."
diameter.
Contains
single nucleus,
THANK
cytosome,
andYOU !!!
retracted
flagella.