Trichomoniasis is a sexually transmitted infection (STI). It is caused by a protozoan parasite Trichomonas Vaginalis. It affects urogenital tract which includes female vagina and male urethra. Trichomoniasis can cause symptoms like itching, vaginal discharge, and pain during urination in women. In men, it causes urethral discharge and discomfort. It is a very prevalent STI, with millions of cases globally each year. Trichomoniasis can lead to severe and serious health issues like increased risk of transmitting or acquiring other STIs and difficulty during pregnancy if it is not treated. Proper diagnosis and immediate treatment are important to manage and control the spread of the infection. Safe sexual activity and regular screening are important to prevent this infection. 

Trichomoniasis is most common disease. About 143 million people are infected globally. It can affect all ages of individuals. The high prevalence rate is seen in sexually active people, specifically whose age is between 16 years to 35 years. Women are more affected than men due to the parasite mainly infected the urogenital tract in women. This can lead to symptoms like itching and vaginal discharge. The symptoms are mild in men.  

The prevalence rate is differed by areas. It is common in areas with low socioeconomic status, and limited healthcare service. Trichomoniasis can occur with other STIs like gonorrhea and chlamydia which can elevate the risk of transmission and complications. Trichomoniasis is a significant risk during pregnancy. It is linked with low birth weight and premature birth. It is important to diagnose and treat pregnant women for this infection. 

Trichomoniasis is mainly transmitted by sexual contact. When an infected patient has sexual contact with the uninfected person, this parasite transmitted. It has a unique structure of undulating membrane and flagella which can make it move to the mucosal cells in the urogenital tract.  

Trichomoniasis lead to inflammation in the urogenital mucosa because of the presence of parasite and immune response of host. This can lead to different symptoms like itching, vaginal discharge, and discomfort. It causes the vaginitis in women. It can lead to symptoms like a greenish yellow, a frothy vaginal discharge with a foul odor. It causes vulvovaginal burning. Itching and pain during intercourse or urination. It causes urethritis in men. It can lead to symptoms like itching, urethral discharge, and minor discomfort.  

Trichomoniasis can lead to a chronic infection in some cases with recurrent symptoms and high risk of complications. It is necessary to know that not every infected individuals have symptoms of this disease.  

Trichomoniasis mainly occurred by the protozoan Trichomonas vaginalis. It contains single celled organism which is motile with unique appearance. Trichomoniasis is transmitted by sexual contact, which includes vaginal, anal, or oral sex with infected individual. The primary source of Trichomonas vaginalis is human. It infects the urogenital tract, which includes the female vagina and male urethra. The risk of trichomoniasis is unprotected sexual intercourse with infected person, multiple sexual partners, and high risk of sexual behaviors.   

Early detection of the disease and treatment are the main prognostic factors. Delay in diagnosis and treatment may cause persistent and worse infection, which can lead to complications. The immune system of host plays role in the progression of infection. Individual who has weak immune system along with HIV and AIDS or other immunosuppressive disease may have a high risk of severe and recurrent infection. 

The presence of other STIs like HIV may lead to complications to the prognosis. Some strains of Trichomonas vaginalis are resistant to common antibiotics, which can affect the treatment. Drug resistance medications can lead to failure of treatment and infection to reoccurrence. Sexual activity with an infected or untreated person can lead to reinfection of this disease after the successful treatment.  

Trichomoniasis may affect any age of individuals who are sexually active.  

• Genital swelling and redness: The external genitalia, which includes the vulva, appear red and swollen.  
• Vaginal discharge: The vaginal discharge appears greenish yellow, frothy, and has a foul odor. It is noticeable in the examination. 
• Vaginal and cervical discharge sampling: The healthcare provider examines the pelvic to confirm the diagnosis. The samples are collected from vagina and cervical discharge for laboratory test. The samples are collected by a cotton swap or a speculum. 
• Visual examination of cervix and vagina: The healthcare provider will examine vaginal wall and cervix for any signs of redness, inflammation, or lesions which are linked with trichomoniasis during pelvic examination.  
• Genital lesions or sores: Trichomoniasis may lead to genital lesions or sores. The healthcare provider will check the genital area for any abnormality.  
• Discomfort and pain: Patient who has trichomoniasis may have pain, tenderness, and discomfort in genital area.  

Trichomoniasis is not linked with specific comorbidities. STIs like HIV and other immunosuppressive disease may be concern. It can affect the treatment and course of infection. 

Acute Presentation: Many patients who have trichomoniasis are asymptomatic. Other may have symptoms like vaginal itching or discomfort, greenish yellow, frothy and foul smell of vaginal discharge, genital swelling and redness, and lower discomfort in abdomen.  

Chronic Presentation: Some individuals have prolonged and persist symptoms which are known. Chronic trichomoniasis may elevate the risk of complication and linked with other health condition.  

Trichomoniasis is diagnosed by laboratory test. The samples are collected from vagina or urethra or urine. The diagnostic tests are nucleic acid amplification test (NAAT), wet mount microscopy, or culture.  

The primary treatment of trichomoniasis is antimicrobial medications. This includes metronidazole (Flagyl) which is most effective against the parasite. The recommended single dose is 2 gm orally. A 7-day course of metronidazole is 500 mg daily 2 times can also be recommended. Tinidazole can also be administered as a single dose of 2 gm or 7-day course of 500 mg 2 times a day.  

Retesting of trichomoniasis is suggested within 3 months of completed treatment specifically for women. This can help to make sure that the infection is completely cleared.  

Individuals should take follow up from healthcare provider if symptoms persist or reoccur after treatment. It is good to not have any sexual activity till both infected person completed the treatment and get confirmation of cure. Correct use of condoms can lower the risk of transmission or reinfection of trichomoniasis or other STIs. 

Dermatology, General

Infectious Disease

Urology

Lifestyle modifications: 

• Abstain from Sexual Activity: It is advisable to not have any sexual activity till both infected person completed the treatment during acute phase. Sexual activity may spread the infection or can occur the reinfection. 
• Safe Sex Practices: Safe sex practices are necessary to prevent trichomoniasis and other STIs. Use polyurethane condoms or latex consistently and correctly during sex.  
• Partner Notification and Treatment: If one is diagnosed with trichomoniasis, it is necessary to inform the other one so they can evaluate and treat them if necessary  
• Regular STI Screenings: Individuals who are sexually active, specifically with multiple partners, must go for regular screening of STIs. 
• Personal Hygiene: Maintain good personal hygiene which include regular bathing and washing the genital are can reduce the risk of infections and irritation. 
• Avoidance of Irritants: Avoid using harsh sops or douches in the genital areas as it disrupts the natural balance of vaginal flora. 

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The primary treatment of trichomoniasis includes the use of nitroimidazoles. It is a class of antimicrobial agents which are effective against this parasite. It includes medications like Tinidazole (Tindamax), Metronidazole (Flagyl), Secnidazole (Solosec), and Clotrimazole. 

• Metronidazole (Flagyl): It is most prescribed medication and available in the form of tablets and topical formulations. A single dose of 2 gm or 7-day course of 500 mg 2 times a day is recommended for oral treatment. It is a well-tolerated medication but can lead to side effects like metallic taste, nausea, and, in some cases, a disulfiram-like reaction along with alcohol consumption 
• Tinidazole (Tindamax): It is an oral nitroimidazole. It is available as a single dose of 2 gm or 7-day course of 500 mg 2 times a day. It has more favourable side effects than metronidazole.  
• Secnidazole (Solosec): It is a new oral nitroimidazole and have long half-life than metronidazole. A single dose of 2 gm of secnidazole is sufficient to treat trichomoniasis. 
• Clotrimazole: It is used along with other nitroimidazoles like metronidazole. It is available in topical formulations like vaginal cream or suppositories. It can manage the fungal infections. It is not recommended alone to treat trichomoniasis. 

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Surgical procedures are not suggested to treat this STI. This can be considered in certain cases with other complication of infections or conditions. 

• Abscess Drainage: Trichomonas vaginalis infection may lead to development of pelvic abscesses or other abscesses in genital or reproductive organs in some cases. Surgical drainage of abscesses can be necessary to reduce symptoms and prevent complications. 
• Management of Complications: Trichomoniasis may lead to severe urological or gynecological complications like prostatitis, cervicitis, or urethritis. Surgical procedures can be necessary to reduce these complications, like cervical or urethral procedures.  
• Coexisting Conditions: Trichomoniasis can occur with other urological or gynecological conditions like genital warts or cervical dysplasia caused by HPV. Surgical procedures are necessary to manage these conditions.  

Dermatology, General

Infectious Disease

Urology

Acute Phase: The main focus is to diagnose the infection and give immediate treatment to eliminate the parasite during the acute phase. 

Trichomoniasis may be asymptomatic and make the diagnosis more challenging. Test the samples like swabs and urine from urogenital or genital area and check for the presence of Trichomonas vaginalis. Laboratory tests like NAATs are used to diagnose.  

Healthcare providers give antimicrobial medications like metronidazole and tinidazole to treat trichomoniasis. Individuals who are sexually contacted are diagnosed, tested, and treated if the infection is present. It is advisable to not have any sexual activity till the curation of disease to prevent the spread of infection. 

Chronic Phase: It includes to manage and prevent trichomoniasis. 

After the antibiotic treatment, patient must go for follow up test to conform the clearance of infection specifically during pregnancy. Take prevention which include safe sex and regular screening of STIs. Education of trichomoniasis is necessary to prevent it. Pregnant women must be closely monitored to premature birth and low birth weight need immediate treatment and follow up.