The following people have a higher chance of getting trich:. As the number of sexual partners that a person has increases, so does their risk of getting trich. Symptoms may appear between 5 and 28 days after exposure, or they may appear later or not at all.
Minor symptoms include irritation, but someone with a more severe case may have inflammation with discharge. Experts have linked trichomoniasis with complications during pregnancy, including:.
At least one study suggests that there may also be a link between trich and human papillomavirus HPV , the virus that causes cervical cancer.
More research is necessary, however, to clarify the association. Scientists believe that this increased risk could be due to:. To diagnose a trichomoniasis infection , a doctor will:. The results of a lab test will come back in about a week. Women should aim to schedule the appointment for a time when they are unlikely to be menstruating. Before the appointment, they should avoid using deodorant on the vulva, as this masks odor and can cause irritation.
The doctor may also advise them to avoid vaginal intercourse or inserting any object, including tampons, into the vagina for 24—48 hours beforehand. A Pap smear test does not check for trich. If a person has a clear Pap test , they may still have trich or another STI. Trich is easy to treat in males and females , including during pregnancy. Treatment usually involves taking a single dose of an antibiotic by mouth. A doctor may also prescribe a vaginal suppository or a cream to apply topically.
Antibiotic medications that kill parasites include metronidazole Flagyl and tinidazole Tindamax. People should not consume alcohol while taking metronidazole, as there may be an adverse reaction, which can lead to abdominal cramps, nausea, headaches, and flushing.
Traditionally, this has been accomplished though cultivation in Diamond's medium, which is not widely available and thus was used mainly for research purposes. However, a new commercially available culture method composed of liquid medium in a clear pouch has been shown to be as good as the traditional research method This method has been used successfully with both clinician-obtained and self-obtained specimens ; the latter is becoming quite useful in situations where pelvic examination is not possible or desirable for example, screening in adolescents or in patients in developing countries.
In addition, a delayed-inoculation technique is possible, allowing for initial reading of the wet preparation and then inoculation of the culture pouch if the wet preparation is negative. Swab specimens may sit at room temperature for up to 30 min prior to pouch inoculation Results of the culture test are available in 2 to 5 days. Considering the suboptimal sensitivity of the wet mount, routine screening using culture may soon become included in the diagnostic workup, especially when high-prevalence populations are being screened.
Survival for up to 24 h in Amies gel agar transport medium has also been documented Self-collected vaginal swab specimens are as sensitive as clinician-obtained for the diagnosis of trichomoniasis More recently, a point-of-care antigen detection test for the diagnosis of trichomoniasis in women has been licensed Genzyme Corp.
Cambridge, Mass. Rapid test performance did not vary with vaginal symptoms or with the presence of other vaginal or cervical syndromes or infections. The rapid assay was more sensitive than wet-preparation microscopy This test may be of value in settings where microscopy is not possible.
PCR-based tests for T. Several groups of investigators have reported their findings on the development of a PCR technique for diagnosis of trichomoniasis in females. In , Riley et al. Subsequently, many additional primer sets have been described 5 , 47 , 49 , Unlike PCR for infections such as gonorrhea and chlamydia, which appears to have greater sensitivity than culture methods, PCR for trichomoniasis in women does not appear to offer a diagnostic advantage.
This may be because T. Successful culture of T. PCR of vaginal swabs may be advantageous in settings where incubation of cultures is not possible and shipping of specimens to a reference laboratory is required. Self-obtained vaginal swab specimens may also be useful for the PCR technique. In addition, PCR may be superior to culture for the diagnosis of T. Of note are the many different primers which have been used for the detection of T.
Direct comparisons of these primers, and perhaps the development of new primers, could prove useful with regard to refining the technique and improving its sensitivity. Diagnosis of this infection is much more difficult for males, with the best culture results yielded by combining urethral swabs and urine sediment for culture PCR appears to have far greater sensitivity in this setting.
Among men attending an STD clinic for a new problem or screening, culture of urethral swab and urine sediment detected T. In a second study, men attending an STD clinic as well as a dermatology clinic in Malawi were studied using wet-mount microscopy and urethral culture as well as PCR detection with urethral swab specimens. In a larger cohort of the same population, the sensitivity and specificity of urine- based PCR were Until recently, metronidazole was the only efficacious antibiotic available in the United States for the treatment of trichomoniasis.
Sexual partners should also be treated. Metronidazole intravaginal gel has limited efficacy and should not be used. Although there continues to be some controversy about the safety of metronidazole in pregnancy, there has never been a documented case of fetal malformation attributed to its use, even when it is used in the first trimester Recently, controversy has also developed concerning the treatment of trichomoniasis in pregnancy and its relationship to preterm birth.
Two studies have recently been published which suggest that treatment of trichomoniasis in pregnancy may actually increase the risk of preterm birth rather than decrease the risk as predicted However, there are limitations to both of these studies. One of the studies used much higher doses of metronidazole than are recommended. In addition, the study was stopped prematurely because of the trend toward preterm birth that was seen, and so the number of women enrolled fell short of the number needed for a definitive analysis The second study was a subanalysis of a study designed to answer questions relating to STD and HIV risk, therefore, it was not designed primarily to answer questions regarding the risks of preterm birth associated with treatment of trichomoniasis in pregnancy Since the publication of these papers, the Centers for Disease Control and Prevention has not revised recommendations for treatment during pregnancy.
Pregnant women may be treated with the 2-g single dose of metronidazole Occasionally patients are allergic to metronidazole. Since there is no effective alternative, desensitization is the only option 18 , Another therapeutic dilemma involves metronidazole resistance in T.
In metronidazole-resistant T. It is estimated that approximately 2. This resistance is relative and can usually be overcome with higher doses of oral metronidazole Intravenous formulations offer no advantage over the oral drug. Some authorities have recommended higher doses of oral medication in combination with pharmacy- prepared intravaginal preparations.
There are limited anecdotal reports of success with paromomycin cream; however, there may also be a high incidence of local side effects associated with this therapy Tinidazole see below may be useful for resistant infections.
Women with asymptomatic infection should be treated. If left untreated, they may later become symptomatic, and they continue to transmit the infection while untreated. Tinidazole is a 5-nitroimidazole compound that is chemically related to metronidazole and has been widely used outside of the United States for treatment of trichomonas.
It was recently licensed for the treatment of trichomoniasis in the United States. It has a plasma half-life twice that of metronidazole 12 to 14 h for tinidazole versus 6 to 7 h for metronidazole 89 , and may have a lower incidence of adverse effects than metronidazole.
Tinidazole may be a good option for patients with infection resistant to metronidazole. Gillette, G. Schmid, D. Mosure, J. Lossick, E. Secor, L. Narcisi, and P. Garnard, Abstr. O67, Six clinical studies have evaluated various doses of tinidazole for treatment of metronidazole-resistant trichomoniasis 35 , 94 , , ; Gillette et al. The largest series of patients was reported by Sobel et al. In this study, 20 patients with clinically refractory trichomoniasis failure to respond to therapy with oral metronidazole at at least mg twice a day for 7 days were treated with high doses of oral and vaginal tinidazole 2 to 3 g orally plus 1 to 1.
In a large multicenter study, after adjusting for demographic, behavioral, and microbiological variables, T. Similarly, Minkoff et al. In that study, the incidence of this complication at term was In another study of pregnant adolescents, T. Veterinary data further support a contribution of Trichomonas infections to adverse outcomes of pregnancy. Bovine venereal trichomoniasis is a cause of abortion in cattle, and a Trichomonas vaccine reduces the occurrence of this complication The exact linkages between colonization or infection of the lower tract in pregnancy and prematurity remain speculative.
The leading hypothesis is that infection triggers local cytokine release, which in turn triggers the onset of labor 76 , a hypothesis for which data continue to accumulate. Several studies have found associations between the presence of biochemical substances which may be involved in the initiation of labor in the vaginal fluid of pregnant women and lower genital tract infections.
These substances include phospholipase A 2 , sialidases, endotoxin, and interleukin-1 alpha 11 , 12 , 73 , Infections associated with elevated levels of these substances within the vaginal or cervical fluids have included trichomoniasis as well as bacterial vaginosis and C. Investigators have also shown a relationship between the presence of elevated cytokine levels in the amniotic fluid and preterm labor.
Hillier et al. They found that the presence of cytokines in the amniotic fluid was related to amniotic fluid infection, histologic chorioamnionitis, and premature delivery In summary, lower genital tract infections, including trichomoniasis, have been linked to elevated levels of enzymes and cytokines within the vaginal fluid and the presence of cytokines within the amniotic fluid has been linked to chorioamnionitis and premature delivery.
Prospective studies of treatment of trichomoniasis during pregnancy for the prevention of preterm birth have yielded disappointing results. Among women with asymptomatic infection who were treated with metronidazole during the second and third trimesters of pregnancy, a trend toward increased preterm delivery was seen compared to the placebo group.
However, the dose of metronidazole used was four times the recommended dose. In addition, the study was stopped prematurely due to a slow accrual of subjects and to the trend for increased risk of preterm delivery in the treatment group A second study, conducted in Uganda, also found that treatment of trichomoniasis during pregnancy resulted in an increase in the incidence of preterm birth.
However, this study was actually a subgroup analysis of a larger trial and was not properly designed to answer the question of the effect of treatment of T. Therefore, the question remains unanswered. Acquisition of HIV has been associated with trichomoniasis in several African studies, possibly as a result of the local inflammation often caused by the parasite. Leroy et al. In a prospective study by Laga et al. Given the higher prevalence and incidence of trichomoniasis than most other treatable STDs in most studies to date, the attributable fraction of HIV acquisitions due to trichomoniasis may eclipse the relative contribution of other STDs Transmission of HIV is enhanced by coinfection with T.
In a study conducted in Malawi, the median HIV RNA concentration in the seminal fluid of men with urethritis was significantly higher in the men with trichomoniasis than in those with symptomatic urethritis due to an unidentified cause In addition, successful treatment of trichomonal urethritis reduced the levels of HIV RNA so that they were similar to those seen in uninfected controls Trichomoniasis is an extremely common infection worldwide and is associated with important public health problems, including amplification of HIV transmission.
Current treatment with metronidazole is reliable and inexpensive; however, the number of strains resistant to metronidazole may be increasing. Important questions remain concerning immunology, complications of pregnancy, accurate diagnosis, and public health control of this infection.
National Center for Biotechnology Information , U. Journal List Clin Microbiol Rev v. Clin Microbiol Rev. Jane R. Author information Copyright and License information Disclaimer. South, Zeigler Research Bldg. Phone: Fax: E-mail: ude. This article has been cited by other articles in PMC. Abstract Trichomoniasis is perhaps the most common curable sexually transmitted disease worldwide, yet few resources are devoted to its control. Phylum: Zoomastigina—possess flagella. Targets of Acquired Immunity The presence of parasite-specific immunoglobulin G 2 and immunoglobulin A responses also indicates priming of helper T cells, although the relevant antigens are largely unknown, as are the exact effects of antibodies on the parasites.
Molecular Mechanisms of Pathogenesis Adhesion is thought to play an important role in the pathogenesis of trichomoniasis, and investigations of the molecular basis of adhesion of T. Hydrolases A variety of hydrolases have been described in T. Cytotoxic Molecules Recent evidence suggests that T. Open in a separate window. Other Molecular Pathogenesis Possibilities The importance of the thioredoxin system as one of the major antioxidant defense mechanisms in trichomonads was confirmed by showing that the parasite responds to environmental changes resulting in increased oxidative stress by upregulating thioredoxin and thioredoxin peroxidases levels.
Sequencing the Genome Progress in sequencing the genome of T. Abraham, M. Desjardins, L. Filion, and G. Inducible immunity to Trichomonas vaginalis in a mouse model of vaginal infection. Addis, M. Rappelli, A. Pinto De Andrade, F. Rita, M. Colombo, P. Cappuccinelli, and P. Identification of Trichomonas vaginalis alpha-actinin as the most common immunogen recognized by sera of women exposed to the parasite.
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Gonzalez-Robles, A. Martinez-Palomo, and J. Trichomonas vaginalis for amoeboid transformation and adhesion synthesis follows cytoadherence. Bachmann, L. Lewis, R. Allen, J. Schwebke, L. Leviton, H. Siegal, and E. Hook III. Risk and prevalence of treatable sexually transmitted diseases at a Birmingham substance abuse treatment facility. Public Health 90 : Bessarab, I. Liu, C. Ip, and J. Virology : Bradley, P.
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Moncla, C. Stevens, and S. Sialidases neuraminidases in bacterial vaginosis and bacterial vaginosis- associated microflora. Burgess, D. Trichomonads and intestinal flagellates, p. Cox, J. Krier, and D. Wakelin ed. University Press, New York, N. Knoblock, T.
Daugherty, and N. Cytotoxic and hemolytic effects of Tritrichomonas foetus on mammalian cells. Identification of Tritrichomonas foetus in sections of bovine placental tissue with monoclonal antibodies. Analysis of adhesion and cytotoxicity of Tritrichomonas foetus to mammalian cells by use of monoclonal antibodies. Cates, W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States.
Centers for Disease Control and Prevention. Coombs, G. Westrop, P. Suchan, G. Puzova, R. Hirt, T. Embley, J. Mottram, and S. The amitochondrial eukaryote Trichomonas vaginalis contains a divergent thioredoxin-linked peroxiredoxin antioxidant system. Cotch, M.
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Draper, D. Donohoe, L. Mortimer, and R. Cysteine proteases of Trichomonas vaginalis degrade secretory leukocyte protease inhibitor. Landers, M. Krohn, S. Hillier, H. Wieseneld, and R. Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections. Parker, E. Patterson, W. Jones, M. Beutz, J. French, K. Borchardt, and J. Dyall, S.
Origins of hydrogenosomes and mitochondria: evolution and organelle biogenesis. Dyer, B. Phylum Zoomastigina Class Parabasalia, p. Margulis, J. Corliss, M. Melkonian, and D. Chapman ed. Jones and Bartlett, Boston, Mass. Engbring, J. Characterization of Trichomonas vaginalis AP33 adhesin and cell surface interactive domains. Microbiology : Fais, S. Fiori, P. Rocchigiani, and P. Trichomonas vaginalis haemolysis: evidence of functional pores formation on red cell membranes.
FEMS Microbiol. Rappelli, and M. The flagellated parasite Trichomonas vaginalis: new insights into cytopathogenicity mechanisms. Fouts, A. Trichomonas vaginalis: re-evaluation of its clinical presentation and laboratory diagnosis. Garber, G. Lemchuk-Favel, and W. Isolation of a cell-detaching factor of Trichomonas vaginalis. 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 , or to pass the HIV virus on to a sex partner.
Pregnant women with trichomoniasis are more likely to have their babies too early preterm delivery. Also, babies born to infected mothers are more likely to have a low birth weight less than 5.
It is not possible to diagnose trichomoniasis based on symptoms alone. For both men and women, your health care provider can examine you and get a laboratory test to diagnose trichomoniasis. Trichomoniasis can be treated with medication prescribed by a doctor. These pills are taken by mouth. It is safe for pregnant women to take this medication. People who have been treated for trichomoniasis can get it again. About 1 in 5 people get infected again within 3 months after receiving treatment.
To avoid getting reinfected, all sex partners should get treated with antibiotics at the same time. Wait to have sex again until everyone has been treated and any symptoms go away usually about a week.
Get checked at 3 months to make sure you have not been infected again, or sooner if your symptoms come back before then. If you are sexually active, you can do the following things to lower your chances of getting trichomoniasis:.
Another approach is to talk about the potential risk of STDs before you have sex with a new partner. That way you can make informed choices about the level of risk you are comfortable taking with your sex life. If you or someone you know has questions about trichomoniasis or any other STD, talk to a health care provider. Box Rockville, MD E-mail: npin-info cdc. Sexually Transmitted Infections Treatment Guidelines,
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