Trichomonas vaginalis:what it is and how it is contracted

Trichomonas vaginalisis a protozoan between 6 and 8 micrometers in size (1 micrometer is equal to 1 thousandth of a millimeter); It is characterized by a short wavy membrane and four flagella that ensure its movement.
Its distribution is cosmopolitan and sexual intercourse is the maincause of transmission.
Contagionthrough objects, linen and clothing is particularly rare and difficult.
The prevalence of this pathogen in developed countries ranges between 5 and 20% in women and between 2 and 10% in men.

Trichomoniasis: symptomatology

In women, the symptoms ofTrichomonas vaginalisinfection can range from an asymptomatic picture tothe presence ofacute manifestations such as:

• Foamy and abundant vaginal discharge of greenish-yellow color
• Vulvarand perineal pain due to the appearance of edema
• Dysuria (urination disorders)
• Pain during urination and sexual activity
• Appearance on the vaginal walls of red spots
• Genital itching
• Bleeding after sexual activity

The absence of symptoms does not preclude the evolution of the infection into a symptomatic pathological picture: asymptomatic infection can turn into a symptomatic infection at any time.
In men in general the infection evolves without symptoms even if sometimes precise discomforts may occur:

• Urethritis with intermittent and foamy leakage
• Dysuria
• Pain when urinating or sex

The symptoms, in male individuals, even if present remain contained. Only rarely trichomoniasis in men can lead to inflammation of the glands attached to the reproductive system such as epididymitis and prostatitis.

The symptomatology appears between 5 and 28 days after exposure to the pathogen due tothe incubation time.

Diagnosis of trichomoniasis

Diagnosisis mainly based on microscopic examination, however nucleic acid amplification tests or tests involving cultivation of the microorganism may also be performed.

The microscopic examination is particularly useful in the diagnosis of the disease in women as it allows to investigate the presence of Trichomonas and bacterial vaginosis at the same time.

Through a swab the doctor, or nurse, takes a small rate of vaginal secretion. Then the operator divides the analyte into two aliquots, each diluted respectively with potassium hydroxide and saline, after which the two samples are placed on two different microscopy slides.

For the evaluation of the fresh potassium hydroxide preparation, the presence of “fishy smell” characteristic ofbacterial vaginitis is evaluated.
The fresh preparation with saline is examined under a microscope in order to investigate the presence of Trichomonas.

In addition to parasites, in the presence of Trichomonas infection, white blood cells are also observed, rushed to the site to fight the pathogen.
In men, the most widely used diagnostic tests are those based on the culture of urine on a plate: in this case a urine sample is incubated in nutrient medium in order to selectively grow the pathogen.

ThePCRamplification test involves the use of specific primers for regions of the Trichomonas genome with consequent detection of the peak of DNA replication, indicating the presence of the pathogen.

Therapies againstTrichomonas vaginalis

Treatment against Trichomonasinvolves the administration of two main types of drugs:

• Metronidazole
• Tinidazole

These compounds are bothantibioticsthat also haveantiparasitic activity. The mechanism of action of drugs used against Trichomonas involves inhibition of nucleic acid synthesis and thus DNA damage.
The administration is single and takes place orally; However, the doctor may also prescribe the drug with the pharmaceutical form of vaginal eggs or as a cream to be applied topically.

To avoid re-infection it is necessary that both sexual partners are treated.
In cases of resistance to drug treatment, which are documented, the doctor may prescribe additional therapies with higher doses of the drug.
Among the main side effects of metronidazole is leukopenia, which is a reduction in the number of white blood cells.

Patients who are taking metronidazole should refrain from alcohol consumption for the duration of therapy as an adverse reaction characterized by abdominal cramps, nausea, headache and flushing may occur.

Complications of trichomoniasis

According to some evidence, Trichomonas can cause complications if contracted during pregnancy including:

• Premature birth
• Early rupture of membranes
• Low birth weight of newborns
• Infertility

The use of Metronidazole and tinidazole should be avoided in the first trimester due to the risk of birth defects. The doctor will be able to evaluate the most suitable therapy depending on the stage of pregnancy.

Trichomonas infection can increase the risk of getting HIV infection, especially in women.
The researchers say the increased risk may be due to:

• States of chronic inflammation due to trichomonas infection
• Decreased level of guard of the immune system due to the presence of trichomonas
• Changes in the bacterial balance of vaginal microbial flora in women that can also change the protective faculties of the immune system.

Prevention

Trichomonas infection occurs mainly sexually. The prevention of trichomoniasis certainly passes from the adoption of preventive measures in the sexual field, first of all the use of condoms. In addition to the use of condoms, it is also good practice to avoid sharing the use of towels and clothing.