Trichomonas vulvovaginitis is the inflammation of vulva and vagina caused by Trichomonas spp. Vaginitis is very common. Most women will have some kind of vaginitis at least once in their lives. Trichomoniasis on the other hand is sexually transmitted and it will be important for sex partners to be treated so it is not passed back and forth.
PHYSICAL & CLINICAL FINDING
- Profuse, yellow, malodorous vaginal discharge and severe vaginal itching
- Vulvar itching
- Intense erythema of the vaginal mucosa
- Cervical petechiae (“strawberry cervix”)
- Some infected men may have symptoms of urethritis, epididymitis or prostatitis
- Asymptomatic in ∼50% of women and 90% of men
- Single-cell protozoan Trichomonas vaginalis
- Multiple sexual partners
- History of previous STDs
- Bacterial vaginosis
- Fungal vulvovaginitis
- Atrophic vulvovaginitis
- Pelvic examination
- Speculum examination
- Mobile trichomonads seen on normal saline preparation: 70% sensitivity
- Elevated pH (>5) of vaginal discharge
- Culture is considered the traditional gold standard laboratory test for diagnosis of TV
- Nucleic acid amplification tests (NAATs) have been developed that combine excellent performance characteristics with a more rapid turnaround time compared with culture.
- APTIMA assays utilize target capture and transcription-mediated amplification (TMA) to selectively purify, amplify, and detect species- specific 16 S ribosomal RNA. APTIMA Trichomonas vaginalis transcription-mediated amplification may be a better laboratory test than culture based on sensitivity and time frame for results.
- NAAT is highly sensitive. The APTIMA T. vaginalis assay is FDA cleared for detection of T. vaginalis from vaginal, endocervical, and urine specimens from women (95%- 100% clinical sensitivity and specificity. The OSOM Trichomonas Rapid Test on vaginal secretions provides results in 10 min with sensitivity of 82% to 95% and specificity of 97% to 100%.
- Microscopic evaluation of wet preparations of genital secretions: convenient and low cost but low sensitivity (51%-65%) in vaginal specimen with even lower sensitivity if there is a delay in evaluating slides.
Condom use: best way to prevent trichomoniasis is through consistent and correct use of condoms during all penile-vaginal sexual encounters.
- Metronidazole 2 g PO × 1 or Tinidazole single 2-g oral dose in both sexes. Treatment of the sexual partner is essential to prevent reinfection.
- Alternative regimen: Metronidazole 500 mg PO BID ×7 days
- Alcohol consumption should be avoided during treatment with metronidazole (at least 24 hr after completion of therapy) and tinidazole (at least 72 hr after completion of therapy) to reduce possibility of disulfiram-like reaction.
- Metronidazole gel: less likely to achieve therapeutic levels; therefore not recommended.
- Metronidazole (retreat): 500 mg PO bid ×7 days.
- Treatment of recurrences: metronidazole 2 g PO qd ×3 to 5 days.
- Allergy, intolerance, or adverse reactions: alternatives to metronidazole are not available. Patients who are allergic to metronidazole can be managed by desensitization.
- Pregnancy: (1). Associated with adverse outcomes (i.e., premature rupture of membranes) (2). Metronidazole 2 g PO ×1 day.
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