Sexually Transmitted Diseases. In: DiPiro, JT, Talbert RL, Yee GC,
Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8004605.
Accessed July 16, 2012.
- Infection of genital and urinary tract
- Caused by Trichomonas vaginalis, flagellated,
transmitted by sexual contact
- Infection by nonsexual contact possible because T.vaginalis survives
up to 45 minutes on moist surfaces.
- Trichomonads isolated from vagina, urethra, and paraurethral
ducts and glands in women
- Infection in extragenital sites may be source for reinfection.
- Reinfection more common when local therapy used alone.
- Co-infection with other sexually transmitted infections
(STIs), e.g., gonorrhea, is common.
- Mutually monogamous sexual relationship between uninfected
- Barrier contraceptive methods
- Unprotected sex
- Number of sexual partners
- Sexual preference
- Age: Two-thirds of STIs occur in persons in teens and twenties.
- Typical presentation of trichomoniasis in men and women
in Table 1.
Table 1. Presentation
of Trichomonas Infections |Favorite Table|Download (.pdf)
Table 1. Presentation
of Trichomonas Infections
|General||Incubation period 3–28 days||Incubation period 3–28 days|
|Organism may be detectable within 48 hr after exposure to
|Site of infection||Most common—urethra||Most common—endocervical canal|
|Others—rectum (usually due to rectal intercourse
in men who have sex with men), oropharynx, eye||Others—urethra, rectum (usually due to perineal
contamination), oropharynx, eye|
May be asymptomatic (more common in men than women) or minimally
Urethral discharge (clear to mucopurulent)
May be asymptomatic or minimally symptomatic
Scant to copious, typically malodorous vaginal discharge
(50–75%) and pruritus (worsens during menses)
Vaginal pH 4.5–6
Inflammation/erythema of vulva, vagina, and/or
|Complications||Epididymitis and chronic prostatitis (uncommon)||Pelvic inflammatory disease and associated complications
(i.e., ectopic pregnancy, infertility)|
|Male infertility (decreased sperm motility and viability)|
Premature labor, premature rupture of membranes, and low-birth-weight
infants (risk of neonatal infections low)
Means of Confirmation
- Simplest and most reliable means of diagnosis: wet-mount
examination of vaginal discharge.
confirmed if characteristic pear-shaped, flagellating organisms
- Newer diagnostic tests such as monoclonal antibody or DNA
probe techniques, as well as polymerase chain reaction (PCR) tests,
highly sensitive and specific.
- Wet-mount examination of vaginal discharge (60–80% sensitivity)
- Not useful in rapid diagnosis because
at least 48 hours needed for growth.
- Useful in men.
- Newer diagnostic tests:
- Monoclonal antibody
or DNA probe techniques
- PCR tests
- Achieve maximal cure rates.
- Prevent relapse.
- Metronidazole and tinidazole only antimicrobial agents
available in United States consistently effective in T. vaginalis infections.
- To achieve maximal cure rates and prevent relapse with single