Trichomoniasis

Question 1

What is trichomoniasis?

Answer 1

A curable sexually transmitted infection caused by the protozoan trichomonas vaginalis (TV)

Question 2

How common is trichomoniasis?

Answer 2

The most common curable STI worldwide

Question 3

What is happening to the incidence and prevalence of trichomoniasis?

Answer 3

Decreasing

Question 4

How does the incidence of trichomoniasis in the UK compare to worldwide statistics?

Answer 4

Less common - 7000 cases in 2016

Question 5

What age group is trichomoniasis most common in?

Answer 5

Under 25s

Question 6

Which ethnic group is trichomoniasis most common in?

Answer 6

Black

Question 7

How is trichomonas vaginalis transmitted?

Answer 7

• Vaginal sexual intercourse

- Rarely vertical transmission at delivery

Question 8

Is trichomonas vaginalis spread through oral or anal sex?

Answer 8

No

Question 9

What type of organism is trichomonas vaginalis?

Answer 9

Anaerobic flagellated protozoan

Question 10

Does trichomonas vaginalis affect males or females?

Answer 10

Both

Question 11

Where can trichomonas vaginalis infect in women?

Answer 11

• Urethra
• Vagina
• Paraurethral glands

Question 12

Where can trichomonas vaginalis affect in men?

Answer 12

• Urethra

- Underneath foreskin

Question 13

What site is most commonly affected by trichomonas vaginalis?

Answer 13

Urethra

Question 14

How many sites are often affected by trichomonas vaginalis?

Answer 14

More than one

Question 15

How does trichomonas vaginalis affect the site it colonises?

Answer 15

Replicates via binary fission whilst destroying epithelial cells through direct cell contact and by the release of cytotoxins

Question 16

How can trichomonas vaginalis affect the immune system?

Answer 16

Binds to host plasma proteins preventing recognition by complement pathway

Question 17

What can trichomonas vaginalis infection increase the risk of contracting?

Answer 17

HIV

Question 18

What are the risk factors for trichomoniasis?

Answer 18

• Multiple sexual partners
• Unprotected sexual intercourse
• History of other STIs
• Older women

Question 19

What proportion of trichomoniasis cases are symptomatic?

Answer 19

Many

Question 20

In which gender is asymptomatic trichomoniasis more common?

Answer 20

Men

Question 21

How do most men with trichomoniasis present?

Answer 21

As a partner of a symptomatic infected woman

Question 22

When do symptoms of trichomoniasis develop after infection?

Answer 22

Within 28 days

Question 23

What are the symptoms of trichomoniasis in women?

Answer 23

• Offensive vaginal discharge
• Abnormal vaginal discharge
• Itchiness or soreness of the vulva
• Dyspareunia
• Dysuria

Question 24

What is the appearance of the discharge in trichomoniasis?

Answer 24

Can be thick or thin and frothy yellow-green colour

Question 25

What are the symptoms of trichomoniasis in men?

Answer 25

- Urethral discharge - Dysuria - Urinary frequency - Pain or itching around foreskin

Question 26

What are the signs of trichomoniasis in women?

Answer 26

- Abnormal vaginal discharge - Vulvitis - Vaginitis - Strawberry cervix

Question 27

What is a strawberry cervix?

Answer 27

Punctate and papilliform appearance

Question 28

What are the signs of trichomoniasis in men?

Answer 28

- Urethral discharge | - Balanoposthitis

Question 29

What is balanoposthitis?

Answer 29

Inflammation of the glans penis

Question 30

How common is balanoposphitis?

Answer 30

Rare

Question 31

What are the differentials for trichomoniasis?

Answer 31

- Other vaginal infections - Other causes of vaginal discharge - Atrophic vaginitis - Post-surgery discharge - Other causes of prostatitis, cervicitis and cystitis

Question 32

What are some other vaginal infections?

Answer 32

- Candidiasis - BV - Chlamydia - Gonorrhoea

Question 33

What are some benign causes of vaginal discharge?

Answer 33

- Physiological - Chemical irritants - Pregnancy

Question 34

What steps are important to attempt to diagnose trichomoniasis before investigations?

Answer 34

- History | - Examination

Question 35

How is trichomoniasis investigated?

Answer 35

Culture and sensitivity testing

Question 36

How are sample obtained for trichomoniasis culture testing in women?

Answer 36

- High vaginal swab from posterior fornix | - OR self administered vaginal swab

Question 37

How are samples obtained for trichomoniasis culture testing in men?

Answer 37

- Urethral swab | - First void urine sample

Question 38

What is required if a patient tests positive for trichomoniasis?

Answer 38

- Contact tracing | - Full STI screen

Question 39

What type of medication is used to treat trichomoniasis?

Answer 39

Anti-protozoan

Question 40

What is the drug of choice for trichomoniasis in men and non-pregnant/breast-feeding women?

Answer 40

Metronidazole

Question 41

What are the treatment regimes for trichomoniasis with metronidazole?

Answer 41

- 2g orally as single dose | - OR 400-500mg BD for 5-7 days

Question 42

What is an alternative single dose medication for trichomoniasis?

Answer 42

2g tinidazole

Question 43

Which contacts should be tested for trichomoniasis?

Answer 43

Any current or previous sexual partners in the preceding 4 weeks

Question 44

For how long should patients with trichomoniasis abstain from sex?

Answer 44

- Whilst being treated | - OR 1 week after single dose

Question 45

When is a test of cure required for trichomoniasis?

Answer 45

- Patient is not responding to treatment | - Re-infected

Question 46

What is the risk of trichomoniasis in pregnancy?

Answer 46

- Pre-term labour - Low birth weight - Maternal post-partum sepsis

Question 47

How is trichomoniasis treated differently in pregnancy?

Answer 47

Avoid high (single) dose metronidazole

Question 48

How is trichomoniasis treated when breast feeding?

Answer 48

- Avoid single dose | - OR avoid breast feeding for 12-24 hours after single dose