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. 2004 Apr;80(2):91–95. doi: 10.1136/sti.2003.005124

Trichomoniasis: clinical manifestations, diagnosis and management

H Swygard 1, A Sena 1, M Hobbs 1, M Cohen 1
PMCID: PMC1744792  PMID: 15054166

Abstract

Trichomonas vaginalis was originally considered a commensal organism until the 1950s when the understanding of its role as a sexually transmitted infection (STI) began to evolve. Trichomoniasis has been associated with vaginitis, cervicitis, urethritis, pelvic inflammatory disease (PID), and adverse birth outcomes. Infection with T vaginalis could have an important role in transmission and acquisition of HIV. T vaginalis is site specific for the genitourinary tract and has been isolated from virtually all genitourinary structures. Asymptomatic disease is common in both men and women, thus screening for disease is important. Various sociodemographic factors have been correlated with presence of T vaginalis, and may be used to predict infection. Diagnosis is usually made from wet mount microscopy and direct visualisation, which are insensitive. DNA amplification techniques perform with good sensitivity, but are not yet approved for diagnostic purposes. In areas where diagnostic methods are limited, management of trichomoniasis is usually as part of a clinical syndrome; vaginal discharge for women and urethral discharge for men. A single dose of metronidazole is effective in the majority of cases. Outside of the United States, other nitroimidazoles may be used and are as effective as metronidazole. Metronidazole resistance is an emerging problem, but its clinical importance is not yet clear. Concomitant treatment of sexual partners is recommended.

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Selected References

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  1. Anorlu R. I., Fagbenro Beyioku A. F., Fagorala T., Abudu O. O., Galadanci H. S. Prevalence of trichomonas vaginalis in patients with vaginal discharge in Lagos, Nigeria. Niger Postgrad Med J. 2001 Dec;8(4):183–186. [PubMed] [Google Scholar]
  2. Bowden F. J., Garnett G. P. Trichomonas vaginalis epidemiology: parameterising and analysing a model of treatment interventions. Sex Transm Infect. 2000 Aug;76(4):248–256. doi: 10.1136/sti.76.4.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Buvé A., Weiss H. A., Laga M., Van Dyck E., Musonda R., Zekeng L., Kahindo M., Anagonou S., Morison L., Robinson N. J. The epidemiology of trichomoniasis in women in four African cities. AIDS. 2001 Aug;15 (Suppl 4):S89–S96. doi: 10.1097/00002030-200108004-00010. [DOI] [PubMed] [Google Scholar]
  4. Crosby R., DiClemente R. J., Wingood G. M., Harrington K., Davies S. L., Hook E. W., 3rd, Oh M. K. Predictors of infection with Trichomonas vaginalis: a prospective study of low income African-American adolescent females. Sex Transm Infect. 2002 Oct;78(5):360–364. doi: 10.1136/sti.78.5.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Czeizel A. E., Rockenbauer M. A population based case-control teratologic study of oral metronidazole treatment during pregnancy. Br J Obstet Gynaecol. 1998 Mar;105(3):322–327. doi: 10.1111/j.1471-0528.1998.tb10094.x. [DOI] [PubMed] [Google Scholar]
  6. Daly C. C., Maggwa N., Mati J. K., Solomon M., Mbugua S., Tukei P. M., Hunter D. J. Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya. Genitourin Med. 1994 Jun;70(3):155–161. doi: 10.1136/sti.70.3.155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DeMeo L. R., Draper D. L., McGregor J. A., Moore D. F., Peter C. R., Kapernick P. S., McCormack W. M. Evaluation of a deoxyribonucleic acid probe for the detection of Trichomonas vaginalis in vaginal secretions. Am J Obstet Gynecol. 1996 Apr;174(4):1339–1342. doi: 10.1016/s0002-9378(96)70682-8. [DOI] [PubMed] [Google Scholar]
  8. Franklin T. L., Monif G. R. Trichomonas vaginalis and bacterial vaginosis. Coexistence in vaginal wet mount preparations from pregnant women. J Reprod Med. 2000 Feb;45(2):131–134. [PubMed] [Google Scholar]
  9. Gülmezoglu A. M., Garner P. Trichomoniasis treatment in women: a systematic review. Trop Med Int Health. 1998 Jul;3(7):553–558. doi: 10.1046/j.1365-3156.1998.00273.x. [DOI] [PubMed] [Google Scholar]
  10. Herzberg A. J., Silverman J. F. Detection of Trichomonas vaginalis in endocervical and ectocervical smears. Diagn Cytopathol. 1996 May;14(3):273–276. doi: 10.1002/(SICI)1097-0339(199604)14:3<273::AID-DC15>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  11. Hobbs M. M., Kazembe P., Reed A. W., Miller W. C., Nkata E., Zimba D., Daly C. C., Chakraborty H., Cohen M. S., Hoffman I. Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis. 1999 Aug;26(7):381–387. doi: 10.1097/00007435-199908000-00003. [DOI] [PubMed] [Google Scholar]
  12. Jackson D. J., Rakwar J. P., Chohan B., Mandaliya K., Bwayo J. J., Ndinya-Achola J. O., Nagelkerke N. J., Kreiss J. K., Moses S. Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management. J Infect Dis. 1997 Apr;175(4):833–838. doi: 10.1086/513979. [DOI] [PubMed] [Google Scholar]
  13. Joyner J. L., Douglas J. M., Jr, Ragsdale S., Foster M., Judson F. N. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. Sex Transm Dis. 2000 Apr;27(4):236–240. doi: 10.1097/00007435-200004000-00010. [DOI] [PubMed] [Google Scholar]
  14. Kaydos-Daniels S. Cornelia, Miller William C., Hoffman Irving, Banda Topia, Dzinyemba Willard, Martinson Francis, Cohen Myron S., Hobbs Marcia M. Validation of a urine-based PCR-enzyme-linked immunosorbent assay for use in clinical research settings to detect Trichomonas vaginalis in men. J Clin Microbiol. 2003 Jan;41(1):318–323. doi: 10.1128/JCM.41.1.318-323.2003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kaydos S. Cornelia, Swygard Heidi, Wise Shelly L., Sena Arlene C., Leone Peter A., Miller William C., Cohen Myron S., Hobbs Marcia M. Development and validation of a PCR-based enzyme-linked immunosorbent assay with urine for use in clinical research settings to detect Trichomonas vaginalis in women. J Clin Microbiol. 2002 Jan;40(1):89–95. doi: 10.1128/JCM.40.1.89-95.2002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kengne P., Veas F., Vidal N., Rey J. L., Cuny G. Trichomonas vaginalis: repeated DNA target for highly sensitive and specific polymerase chain reaction diagnosis. Cell Mol Biol (Noisy-le-grand) 1994 Sep;40(6):819–831. [PubMed] [Google Scholar]
  17. Kingston M. A., Bansal D., Carlin E. M. 'Shelf life' of Trichomonas vaginalis. Int J STD AIDS. 2003 Jan;14(1):28–29. doi: 10.1258/095646203321043228. [DOI] [PubMed] [Google Scholar]
  18. Klebanoff M. A., Carey J. C., Hauth J. C., Hillier S. L., Nugent R. P., Thom E. A., Ernest J. M., Heine R. P., Wapner R. J., Trout W. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001 Aug 16;345(7):487–493. doi: 10.1056/NEJMoa003329. [DOI] [PubMed] [Google Scholar]
  19. Krieger J. N. Consider diagnosis and treatment of trichomoniasis in men. Sex Transm Dis. 2000 Apr;27(4):241–242. doi: 10.1097/00007435-200004000-00011. [DOI] [PubMed] [Google Scholar]
  20. Krieger J. N., Jenny C., Verdon M., Siegel N., Springwater R., Critchlow C. W., Holmes K. K. Clinical manifestations of trichomoniasis in men. Ann Intern Med. 1993 Jun 1;118(11):844–849. doi: 10.7326/0003-4819-118-11-199306010-00003. [DOI] [PubMed] [Google Scholar]
  21. Krieger J. N. Trichomoniasis in men: old issues and new data. Sex Transm Dis. 1995 Mar-Apr;22(2):83–96. [PubMed] [Google Scholar]
  22. Krieger J. N., Verdon M., Siegel N., Holmes K. K. Natural history of urogenital trichomoniasis in men. J Urol. 1993 Jun;149(6):1455–1458. doi: 10.1016/s0022-5347(17)36414-5. [DOI] [PubMed] [Google Scholar]
  23. Lara-Torre Eduardo, Pinkerton Jay S. Accuracy of detection of trichomonas vaginalis organisms on a liquid-based papanicolaou smear. Am J Obstet Gynecol. 2003 Feb;188(2):354–356. doi: 10.1067/mob.2003.8. [DOI] [PubMed] [Google Scholar]
  24. Lawing L. F., Hedges S. R., Schwebke J. R. Detection of trichomonosis in vaginal and urine specimens from women by culture and PCR. J Clin Microbiol. 2000 Oct;38(10):3585–3588. doi: 10.1128/jcm.38.10.3585-3588.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lo Min, Reid Murray, Brokenshire Michael. Epidemiological features of women with trichomoniasis in Auckland sexual health clinics: 1998-99. N Z Med J. 2002 Aug 9;115(1159):U119–U119. [PubMed] [Google Scholar]
  26. Mbizvo E. M., Msuya S. E., Stray-Pedersen B., Sundby J., Chirenje Z. M., Hussain A. Determinants of reproductive tract infections among asymptomatic women in Harare, Zimbabwe. Cent Afr J Med. 2001 Mar;47(3):57–64. doi: 10.4314/cajm.v47i3.8595. [DOI] [PubMed] [Google Scholar]
  27. Moodley Prashini, Wilkinson David, Connolly Cathy, Moodley Jack, Sturm A. Willem. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. 2002 Jan 7;34(4):519–522. doi: 10.1086/338399. [DOI] [PubMed] [Google Scholar]
  28. Morency P., Dubois M. J., Grésenguet G., Frost E., Mâsse B., Deslandes S., Somsé P., Samory A., Mberyo-Yaah F., Pépin J. Aetiology of urethral discharge in Bangui, Central African Republic. Sex Transm Infect. 2001 Apr;77(2):125–129. doi: 10.1136/sti.77.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Narcisi E. M., Secor W. E. In vitro effect of tinidazole and furazolidone on metronidazole-resistant Trichomonas vaginalis. Antimicrob Agents Chemother. 1996 May;40(5):1121–1125. doi: 10.1128/aac.40.5.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Niccolai L. M., Kopicko J. J., Kassie A., Petros H., Clark R. A., Kissinger P. Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women. Sex Transm Dis. 2000 May;27(5):284–288. doi: 10.1097/00007435-200005000-00009. [DOI] [PubMed] [Google Scholar]
  31. Ohlemeyer C. L., Hornberger L. L., Lynch D. A., Swierkosz E. M. Diagnosis of Trichomonas vaginalis in adolescent females: InPouch TV culture versus wet-mount microscopy. J Adolesc Health. 1998 Mar;22(3):205–208. doi: 10.1016/s1054-139x(97)00214-0. [DOI] [PubMed] [Google Scholar]
  32. Pastorek J. G., 2nd, Cotch M. F., Martin D. H., Eschenbach D. A. Clinical and microbiological correlates of vaginal trichomoniasis during pregnancy. The Vaginal Infections and Prematurity Study Group. Clin Infect Dis. 1996 Nov;23(5):1075–1080. doi: 10.1093/clinids/23.5.1075. [DOI] [PubMed] [Google Scholar]
  33. Patel S. R., Wiese W., Patel S. C., Ohl C., Byrd J. C., Estrada C. A. Systematic review of diagnostic tests for vaginal trichomoniasis. Infect Dis Obstet Gynecol. 2000;8(5-6):248–257. doi: 10.1155/S1064744900000375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pépin J., Sobéla F., Deslandes S., Alary M., Wegner K., Khonde N., Kintin F., Kamuragiye A., Sylla M., Zerbo P. J. Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis. Bull World Health Organ. 2001;79(2):118–126. [PMC free article] [PubMed] [Google Scholar]
  35. Reynolds M., Wilson J. Is Trichomonas vaginalis still a marker for other sexually transmitted infections in women? Int J STD AIDS. 1996 Mar-Apr;7(2):131–132. doi: 10.1258/0956462961917339. [DOI] [PubMed] [Google Scholar]
  36. Ryan K. A., Zekeng L., Roddy R. E., Weir S. S. Prevalence and prediction of sexually transmitted diseases among sex workers in Cameroon. Int J STD AIDS. 1998 Jul;9(7):403–407. doi: 10.1258/0956462981922494. [DOI] [PubMed] [Google Scholar]
  37. Sayed el-Ahl Saedia A., el-Wakil Hala S., Kamel Nagwa M., Mahmoud Manal S. E. A preliminary study on the relationship between Trichomonas vaginalis and cervical cancer in Egyptian women. J Egypt Soc Parasitol. 2002 Apr;32(1):167–178. [PubMed] [Google Scholar]
  38. Schmid G., Narcisi E., Mosure D., Secor W. E., Higgins J., Moreno H. Prevalence of metronidazole-resistant Trichomonas vaginalis in a gynecology clinic. J Reprod Med. 2001 Jun;46(6):545–549. [PubMed] [Google Scholar]
  39. Schneider H., Coetzee D. J., Fehler H. G., Bellingan A., Dangor Y., Radebe F., Ballard R. C. Screening for sexually transmitted diseases in rural South African women. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S147–S152. [PubMed] [Google Scholar]
  40. Schwebke J. R., Morgan S. C., Pinson G. B. Validity of self-obtained vaginal specimens for diagnosis of trichomoniasis. J Clin Microbiol. 1997 Jun;35(6):1618–1619. doi: 10.1128/jcm.35.6.1618-1619.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Schwebke J. R., Venglarik M. F., Morgan S. C. Delayed versus immediate bedside inoculation of culture media for diagnosis of vaginal trichomonosis. J Clin Microbiol. 1999 Jul;37(7):2369–2370. doi: 10.1128/jcm.37.7.2369-2370.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Sobel J. D., Nyirjesy P., Brown W. Tinidazole therapy for metronidazole-resistant vaginal trichomoniasis. Clin Infect Dis. 2001 Sep 17;33(8):1341–1346. doi: 10.1086/323034. [DOI] [PubMed] [Google Scholar]
  43. Sorvillo F., Kovacs A., Kerndt P., Stek A., Muderspach L., Sanchez-Keeland L. Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention. Am J Trop Med Hyg. 1998 Apr;58(4):495–500. doi: 10.4269/ajtmh.1998.58.495. [DOI] [PubMed] [Google Scholar]
  44. Sorvillo F., Smith L., Kerndt P., Ash L. Trichomonas vaginalis, HIV, and African-Americans. Emerg Infect Dis. 2001 Nov-Dec;7(6):927–932. doi: 10.3201/eid0706.010603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Spinillo A., Bernuzzi A. M., Cevini C., Gulminetti R., Luzi S., De Santolo A. The relationship of bacterial vaginosis, Candida and Trichomonas infection to symptomatic vaginitis in postmenopausal women attending a vaginitis clinic. Maturitas. 1997 Jul;27(3):253–260. doi: 10.1016/s0378-5122(97)00038-8. [DOI] [PubMed] [Google Scholar]
  46. Sutton M. Y., Sternberg M., Nsuami M., Behets F., Nelson A. M., St Louis M. E. Trichomoniasis in pregnant human immunodeficiency virus-infected and human immunodeficiency virus-uninfected congolese women: prevalence, risk factors, and association with low birth weight. Am J Obstet Gynecol. 1999 Sep;181(3):656–662. doi: 10.1016/s0002-9378(99)70509-0. [DOI] [PubMed] [Google Scholar]
  47. Vishwanath S., Talwar V., Prasad R., Coyaji K., Elias C. J., de Zoysa I. Syndromic management of vaginal discharge among women in a reproductive health clinic in India. Sex Transm Infect. 2000 Aug;76(4):303–306. doi: 10.1136/sti.76.4.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Waghorn D. J., Tucker P. K., Chia Y., Spencer S., Luzzi G. A. Collaborative approach to improve the detection and management of trichomoniasis in a low prevalence district. Int J STD AIDS. 1998 Mar;9(3):164–167. doi: 10.1258/0956462981921792. [DOI] [PubMed] [Google Scholar]
  49. Watson-Jones D., Mugeye K., Mayaud P., Ndeki L., Todd J., Mosha F., West B., Cleophas-Frisch B., Grosskurth H., Laga M. High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study. Sex Transm Infect. 2000 Oct;76(5):355–362. doi: 10.1136/sti.76.5.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Wendel K. A., Erbelding E. J., Gaydos C. A., Rompalo A. M. Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect. 2003 Apr;79(2):151–153. doi: 10.1136/sti.79.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Wendel Karen A., Erbelding Emily J., Gaydos Charlotte A., Rompalo Anne M. Trichomonas vaginalis polymerase chain reaction compared with standard diagnostic and therapeutic protocols for detection and treatment of vaginal trichomoniasis. Clin Infect Dis. 2002 Aug 6;35(5):576–580. doi: 10.1086/342060. [DOI] [PubMed] [Google Scholar]
  52. Wiese W., Patel S. R., Patel S. C., Ohl C. A., Estrada C. A. A meta-analysis of the Papanicolaou smear and wet mount for the diagnosis of vaginal trichomoniasis. Am J Med. 2000 Mar;108(4):301–308. doi: 10.1016/s0002-9343(99)00466-0. [DOI] [PubMed] [Google Scholar]
  53. Wiesenfeld H. C., Lowry D. L., Heine R. P., Krohn M. A., Bittner H., Kellinger K., Shultz M., Sweet R. L. Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Sex Transm Dis. 2001 Jun;28(6):321–325. doi: 10.1097/00007435-200106000-00003. [DOI] [PubMed] [Google Scholar]
  54. duBouchet L., McGregor J. A., Ismail M., McCormack W. M. A pilot study of metronidazole vaginal gel versus oral metronidazole for the treatment of Trichomonas vaginalis vaginitis. Sex Transm Dis. 1998 Mar;25(3):176–179. doi: 10.1097/00007435-199803000-00012. [DOI] [PubMed] [Google Scholar]
  55. duBouchet L., Spence M. R., Rein M. F., Danzig M. R., McCormack W. M. Multicenter comparison of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine hydrochloride, and allantoin in the treatment of symptomatic trichomoniasis. Sex Transm Dis. 1997 Mar;24(3):156–160. doi: 10.1097/00007435-199703000-00006. [DOI] [PubMed] [Google Scholar]
  56. el Seoud S. F., Abbas M. M., Habib F. S. Study of trichomoniasis among Egyptian male patients. J Egypt Soc Parasitol. 1998 Apr;28(1):263–270. [PubMed] [Google Scholar]

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