Trichomonas, a parasite.
Trichomonas comes from the genus of the trichomonadidae family.
They are urogenital and anaerobic flagellated protozoan parasites,
kind of mixing up everything possible and as you look at the image in front of you,
they have a rather nonspecific shape.
Transmission of trichomonas is sexually transmitted.
The incubation period is from 5 to 28 days and the classic human pathogen is trichomonas vaginalis,
that subspecies name, vaginalis, tells you of course if you need any reminder
that this is a sexually transmitted disease.
Primary infection occurs via the cervical vaginal epithelium.
The trichomonas which can be an external colonizer is able to bind happily,
unfortunately, to underlying host epithelium and after it binds it creates a tight adherence
and has then release of it's contact independent factor such as hemolytic factor
and able to drive a further immune response.
So it’s localized immune response to the factors released by trichomonas vaginalis
that create the clinical symptoms we’ll talk about shortly.
But there is another virulent effect which is also demonstrated on the graph in front of you
and this is that trichomonas and bindings so,
so strongly so adherently to the vaginal epithelium is able to disrupt the normal microbia,
the normal flora which is vaginal epithelium normally contains
and it is that normal balance which allows for proper maintenance of pH.
So the vascular pH, the vaginal pH may become disrupted one for too acidic
or too alkaline flow and that creates further irritation on top of the inflammatory disease
caused by the trichomonas by itself.
The diagnosis of trichomonas is by visualizing the trophozoites,
the sort of an oocyte form in any sort of secretion from the cervix,
the vagina or even from the urethra if a penile swab was obtained.
However, the swabs himself have a poor sensitivity, one can easily miss the appearance
of the trophozoites and so culture is now and still the gold standard.
Increasingly though, however, nucleic acid tests are becoming far more used in common clinical practice
because they’re relatively easy to perform at bedside, they can be done quite rapidly
and they have even much and even better sensitivity and specificity than culture
which still relies on human eyes for proper description.
So what are the clinical manifestations?
In women, there is a frothy foul smelling discharge
which is many times yellowish to yellowish and greenish depending
on the bacterial superinfection with that disruption of normal vaginal microbial flora.
In addition, because of the pH changes and the irritative factors that I’ve just described,
there is pain, burning, itching - this is a very unpleasant maybe not excruciating
but a very unpleasant experience to have.
The inflammation further will cause a strawberry cervix on direct visualization
such as you see in the image in front of you.
The cervix which normally is a healthy light pink in color here appears
to have dotted erythematous papules on top of a hyperemic erythematous base,
so you can imagine why it’s in fact described as a strawberry.
Importantly, even at this stage, with a strawberry cervix and a foul smelling discharge,
one would still need to distinguish this particular vaginitis from that caused by Gardnerella vaginalis
which causes a similar frothy or fishy smelling discharge and inflamed appearance of the cervix.
Men appear to get off easy. Disease in men is actually asymptomatic.
This doesn’t mean that they don’t need of treatment
this doesn’t mean that they’re not infected with the trichomonas,
it simply means that they don’t have active symptoms or penile urethral discharge from this.
So what is the treatment?
It is for both the patient and the partner and it is the drug, metronidazole, which is highly active.
It’s good against anaerobic bacteria, it’s good against amoeba
and it’s especially good against trichomonas.
Trichomonas vaginalis, the name says it all.
A sexually transmitted parasitic type disease which causes very prominent vaginitis in the women
but both partners require treatment.