Trichomonas vaginalis incidence:
* Responsible for 20% of vaginitis (the 3rd most common).
Trichomonas vaginalis aetiology:
♦♦♦ Causative organism: trichomonas vaginalis
* Flagellated protozoon characterized by:
– Shape: pear-shaped.
– Size: slightly larger than a leucocyte.
– Structure:
• Single nucleus.
• Undulating membrane.
• Long tail.
• Anterior 4 flagellae.
♦♦♦ Route of infection:
* Sexual route:
– Sexual intercourse is the commonest.
– The organism may be found in male genital tract.
* Non-sexual route:
– Contaminated infected utensils.
– Autoinfection from the rectum (this explains infection in virgins).
– Exacerbation of a carrier state (↓resistanceinfected state).
♦♦♦ Predisposing factors:
– Gonorrhea & pregnancy.
– Corticosteroid & antibiotic treatment.
– Cystitis & urethritis.
Trichomonas vaginalis diagnosis:
– Incubation period: 3 -30 days.
– Onset: post menopausal (flourishes in weak acidic medium).
– Sites of infection: can occur in the vulva, vagina, urethra & bladder.
♦♦♦ Symptoms:
– Vaginal discharge (the main symptom): thin, profuse, yellowish, frothy & offensive.
– Pruritus vulvae: mild.
– Pain & soreness of the vulva: leading to 2ry vulvitis.
– Dyspareunia: due to tender vagina.
– Frequency & burning micturition: due to irritation of urethral meatus.
– Dysuria: if UB is involved.
♦♦♦ Signs:
– Vulva: may be inflamed i.e. red & tender.
– Vagina: strawberry vagina: shows small dark red hemorrhagic spots.
– Cervix: *may be free.
*may be involved: *Flea bitten cervix: spots like that of the vagina.
*Eccentric erosion: red area to one side of the external os.
Trichomonas vaginalis complications:
– PROM & preterm labour.
– Infection after abortion.
Trichomonas vaginalis investigations:
* Fresh drop examination (wet film):
– Drop of vaginal discharge and drop of warm saline (high power microscope): shows
movement of the organism.
* Stained film: Using Leishman stain.
* Culture: best method for diagnosis (kupferberg Whittington medium & Feinberg medium).
* PH: 5.5 – 6.5
Trichomonas vaginalis treatment:
♦♦♦ General measures:
– Husband should take the same course.
– No sexual intercourse during treatment.
– Better result by repeating the course by one week.
– Vaginal douches acidic e.g. lactic acid.
♦♦♦ Local treatment (not preferred):
* Indications of local treatment:
– Drug intolerable orally,
– Pregnant woman in 1st trimester (teratogenicity),
– Lactating woman (excreted in milk).
* Prescription:
– Metronidazole: 500 mg vaginally at night for 7 days.
– Clotrimazole: less effective & can be used during pregnancy.
♦♦♦ Systemic treatment:
– Metronidazole; – 2 g orally for 1 dose (preferred), or
– 500 mg orally twice daily for 7 days.
– Tinidazole: 2 grams orally for 1 dose
Trichomonas vaginalis Persistent or Recurrent Cases
* Detect predisposing factor and manage it.
* Treatment of male partner.
* No sexual intercourse during course of treatment.
* Prolong course of treatment and increase the dose for both partners.
– Metronidazole tab.: – 500 mg PO bid for 14 days
– Metronidazole gel: – 5g PV bid for 5 days.
– Povidone-Iodine Suppository PV bid for 14 days.
– Clotrimazole 100 mg vag tab PV qhs for 7 days.
* Better results obtained by treatment on two weeks separated by one week off.
Trichomonas vaginalis videos:
Trichomonas vaginalis video
Trichomonas vaginalis dividing video
Kochan P, Pietrzyk A, Papir B, Bulanda M. Trichomonas multiplication in a new light – binary fission, cytokinesis or else? World J Med Images Videos Cases 2017; 3:e5-8.
NEW DISCOVERY! Trichomonas vaginalis multiplication – new footage of the complete process video
This film show the multiplication process of Trichomonas in a 24-48 Diamond’s medium using light microscopy. This may be one of the first times that such complete process is filmed. The process doesn’t correspond to descriptions in the literature and medical textbooks where longitudinal binary fission is most often cited (only recently pseudocysts were found to be possibly infectious in a mouse model). Even DPDx branch of CDC shows binary fission on it’s lifecycle as 2 cells splitting evenly. In the film registered here the multiplication process is as follows:
1.Trophozoite at first forms a tumorous bleb;
2.The bleb grows in size more and more resembling a small trophozoite – contrary to some authors this “pseudocyst” is often motile;
3.A kind of an umbilical cord (from the axostyle?) is formed with the trophozoites visibly attached later on via axostyle;
4.Usually other trophozoites come near the multiplying one. We called them the “midwife” trophozoites;
5.The process is not so easy, sometimes both or the parent trophozoite dies;
6.The “midwife” trophozoites in many cases seem to help in detachment of the offspring trophozoite;
7.The offspring trophozoite rotates, turns around its own axis and moves energetically to liberate itself from the parent. Karla Ribeiro et al. published an article in 2000 entitled: Contributions of the Axostyle and Flagella to Closed Mitosis in the Protists Tritrichomonas foetus and Trichomonas vaginalis later followed by other Brazilian authors
Trichomonas vaginalis PPT (power point presentations):
Trichomonas vaginalis PPT
Trichomoniasis PPT