Trichomoniasis is an inflammatory disease classified as one of the sexually transmitted diseases (STD). It is caused by a protozoan called Trichomonas vaginalis. Trichomonas vaginalis is a parasite that lives exclusively in vagina and urethra, although it may survive for several minutes to hours in semen, urine, and thermal water. It is a pear-shaped unicellular organism that moves with four flagella. It causes acute inflammation of the vaginal and urethral mucosa. Trichomoniasis affects mainly women aged 15-35 years; it is estimated that around 170 million women are affected every year.
Epidemiology of Trichomoniasis
Trichomoniasis is worldwide one of the most common sexually transmitted diseases. However, most people have almost no knowledge about it or do not consider it as serious as HIV/AIDS, gonorrhea or syfilis. Trichomoniasis is transmitted solely through sexual contact with infected person. Men are reservoir for the infection because the infection in men is almost always asymptomatic. Rarely, the infection can be transmitted also in very bad hygienic conditions, using the same towels or in thermal pools, where protozoa can survive for several hours. The disease does not leave any life-long immunity so that one person can be repeatedly infected. The disease does not directly threaten the life of the patient; anyway, it can be very annoying. It is essential to consult a doctor, whenever there is a suspicion of this disease.
Symptoms of Trichomoniasis
Trichomoniasis manifests in the form of painful inflammation of the vaginal mucosa, called vaginitis. The first symptoms occur 4-14 days after exposure to the agent. If untreated, the disease passes into chronic stage, when individual symptoms may disappear, but the person is still infectious and can infect sexual partners.
Trichomoniasis in Women
The main symptom of trichomoniasis in women is abundant vaginal discharge, which may be white, yellowish or greenish. It is often frothy and putrid smelling. Other symptoms include severe itching in the area of vaginal opening, pain during sexual intercourse and urination, redness and swelling of the external genitalia or swelling of the lymph nodes.
Trichomoniasis in Men
In men, trichomoniasis manifests as inflammation of the urethra, which is moderate or - in most cases - entirely asymptomatic. If symptoms do occur, the patient may feel frequent urgency to urinate and during urination there may be itching, burning, cutting, and pain present.
Diagnosis of Trichomoniasis
The diagnosis of trichomoniasis is usually based on a microscopic evaluation of the presence of the bacterium Trichomonas vaginalis in the vaginal swab of women or a smear from the urethra in men. In men, microscopic examination often does not reveal the infection as the number of bacteria in the urethra is usually very low. It is therefore necessary to add culture test to the diagnostic algorithm. Culture test is also performed in asymptomatic women who are at high risk of infection.
Treatment of Trichomoniasis
For the treatment of trichomoniasis medicament called metronidazole is widely used. Orally used tablets are usually combined with suppositories into the vagina. The treatment lasts 7 days; alcohol and sexual abstinence should be followed during the treatment. It is important to treat all sexual partners simultaneously. Metronidazole should not be used by women during pregnancy. Especially in the first trimester of pregnancy, the treatment of trichomoniasis is based on the use of topical vaginal medicaments, such as clotrimazole.
Prevention of Trichomoniasis
The best prevention of trichomoniasis is the same as in other sexually transmitted diseases – safe sex principles (condom use) and partner faithfulness.
Complications of Trichomoniasis
Untreated trichomoniasis in pregnant women can cause premature birth or birth of a child with low birth weight. Trichomoniasis can also increase the risk of transmission of HIV infection because it facilitates the entry of the virus into the body. Untreated or inadequately treated trichomoniasis may also contribute to infertility, higher incidence of pelvic inflammatory disease in women and chronic inflammation of the prostate gland in men.