Trichomoniasis

Trichomoniasis is a sexually-transmitted protozoan infection. Men are usually asymptomatic. Women have vaginal discharge (yellow and malodorous). FDA approved NAATs with highest sensitivity/specificity and low turnaround time are now the gold standard in laboratory testing.

CASES/YEAR

1,100,000 (US); 275,000,000 (Global)

CATEGORY

Sexually-Transmitted

AGENT TYPE

Protozoa

OTHER NAMES

Trichomonas vaginalis infection;

ACUITY

Acute-Moderate

INCUBATION

5-28 days; [CCDM]

INITIAL SYMPTOMS

Men: usually asymptomatic; Women: vaginal discharge (yellow and malodorous);

PRECAUTIONS

Standard

COMMENTS

About 70% of infected persons are asymptomatic. The main symptoms are mild to moderate genital inflammation (itching, vaginitis, urethritis, or prostatitis). The discharge is malodorous. Patients with Trichomonas infections are at increased risk for other sexually transmitted infections. [CCDM, p. 626-7] T. vaginalis infections in men vary from asymptomatic (up to 75% of cases) to severe urethritis complicated by epididymitis or prostatitis. Urethritis is marked by mucoid or purulent discharge starting less than 10 days after exposure. For cases in women with abdominal tenderness, pelvic inflammatory disease may be a complication. [ABX Guide] The vaginal discharge is gray-yellow and frothy with a pH >4.5, contains leukocytes, and produces a positive whiff test (foul fishy odor when KOH added to smear). Symptoms may include vulvovaginal irritation, abdominal pain, dysuria, and in males, urethritis. Rarely T. vaginalis causes epididymitis and penile ulceration in males, pelvic inflammatory disease in females, and fetal growth retardation. Wet mounts have a sensitivity of about 60% in females; sensitivity is about 50% in males if a platinum loop is used to scrape the anterior urethra. Prostate massage prior to urine collection for T. vaginalis culture is a more sensitive method in males. [Cecil, p. 2114-5]

DIAGNOSTIC

For women, saline prep (motile trichomonads) is 60-70% sensitive compared to culture; [ABX Guide] FDA approved NAATs with highest sen/spec and low turnaround time are now the gold standard. [Wallach, p. 918]

SCOPE

Global

SIGNS & SYMPTOMS

G abdominal pain
S ulcer of skin
*epididymo-orchitis

ANTIMICROBIC

Yes

VACCINE

ENTRY

Sexual Contact

RESERVOIR

Human

RISK FACTORS

DRUG LINK

Merck Manual: Trichomoniasis

REFERENCES FOR CASES/YEAR

1. (US) Estimated 1.1 million new cases/year in US (men & women); [5MCC-2020]
2. (Global) >275 million new cases worldwide; [5MCC-2020]