Symptoms
In women, trichomoniasis manifests as inflammation of the vaginal mucosa with redness, swelling, and a frothy, thin, yellowish-green, foul-smelling discharge. The urethra and cervix may also be infected. The type of discharge varies. In addition, there may be itching, small skin bleeding, and pain during sexual intercourse and urination. In men, the disease is usually asymptomatic or mild with mild irritation or a burning sensation after urination. The urethra, prostate, and seminal ducts may become colonized and rarely inflamed. Untreated trichomoniasis may persist for months to years. Relapses are relatively common.
Causes and transmission
Trichomoniasis is caused by the pear-shaped protozoan and flagellate. The unicellular parasite binds to vaginal epithelial cells, raising pH and releasing cytotoxic substances that damage the epithelium and cause inflammation. Trichomonads are transmitted primarily during sexual intercourse. The incubation period ranges from about 2 to 28 days. It mainly affects the sexually active population, i.e. adolescents and adults.
Complications
Trichomoniasis was originally considered a trivial nuisance. However, the condition has since been implicated as a possible risk factor for a number of complications. These include risk of miscarriage or premature birth in pregnant women, decreased birth weight of the newborn, cervical neoplasia, pelvic inflammatory disease, infertility, and chronic prostatitis in men. Inflammation can make one more susceptible to transmitting HIV infection.
Risk factors
Risk factors include frequent sexual partner change, other sexually transmitted diseases, and low socioeconomic status.
Diagnosis
Diagnosis is made by medical treatment. Several laboratory methods are available. Because other conditions cause similar symptoms, the diagnosis cannot be made based solely on clinical symtoms. Possible differential diagnoses include vaginal fungus, bacterial vaginosis, and cystitis.
Drug treatment
Oral treatment:Antiparasitic nitroimidazoles are used for drug therapy: Metronidazole (Flagyl) or Ornidazole (Tiberal). Metronidazole is more common in practice. For short-term therapy, a single dose of 2.0 g of metronidazole is given in the evening, equivalent to 4 tablets of 500 mg each. Simultaneous food intake delays absorption but does not reduce it. Alternatively, the drug is taken at a lower dose for 5, 7, or 10 days, depending on the regimen and country (e.g., Switzerland: 10 days, 2 x 250 mg; USA: 7 days, 2 x 500 mg). Short- and long-term therapy are about equally effective, but more adverse effects may occur with short-term therapy. Side effects include nausea, vomiting, and metallic taste. Drug treatment of sexual partners is necessary to prevent reinfection. According to the literature, all partners in the last 3 months should be treated (because the infection persists for a long time if untreated and patients remain infectious). Alcohol should not be consumed during therapy with metronidazole because antabuse effects may occur. This does not apply to ornidazole. Tinidazole and other nitroimidazoles are other possible options, but are not or no longer commercially available in many countries. For treatment of special patient groups (pregnant women, children, patients with underlying diseases, resistance), please refer to the literature. Local treatment: The exclusively local therapy with metronidazole (Flagyl Ovula), the azole antimycotic clotrimazole (e.g. Gyno-Canesten) or disinfectants such as povidone–iodine (Betadine Ovula) or dequalinium chloride (Fluomizin) in the form of creams or vaginal tablets can lead to success in some patients. However, the success rate is lower and sometimes unacceptable. According to the drug information leaflet, metronidazole ovules should only be used to support oral treatment.
