Pediatric Trichomoniasis 

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Background

Trichomoniasis, a type of vaginitis, is predominantly a sexually transmitted disease (STD). Because of both the common practice of self-diagnosis and treatment and diagnosis by practitioners without adequate testing, a number of individuals with trichomoniasis are misdiagnosed. Self-diagnosis is fostered by the ease with which over-the-counter treatment agents are obtained. The symptoms and signs of trichomoniasis are nonspecific, and diagnosis requires basic testing, such as a wet mount.

Trichomoniasis results in missed days from school or work because of the discomfort that it causes, so this infection should not be trivialized. Incidence of coinfection with other STDs is important and needs to be considered when making the diagnosis of trichomoniasis. Trichomoniasis is problematic for the adolescent who contracts it because of the myriad of possible presenting symptoms and because of the complications associated with this disease.

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Pathophysiology

In prepubertal girls, the healthy vaginal wall is thin and hypoestrogenic, the healthy vaginal pH is greater than 4.7, and culture of the vagina demonstrates a number of organisms. As the girl enters adolescence, the vagina thickens, and lactobacilli become the predominant species. The pH of the vagina decreases to less than 4.5.

Lactobacilli are important in protecting the vagina from infection and they remain the dominant, but not the only, flora of the vagina. The range of the incubation period, before symptoms of trichomoniasis develop, is 3-28 days. During infection with the protozoan Trichomonas vaginalis, jerky motile trichomonads may be observed on wet mount. The vaginal pH increases, as does the number of polymorphonuclear (PMN) leukocytes.

PMN leukocytes are the predominant host defense mechanisms and respond to chemotactic substances released by trichomonads. T vaginalis destroys epithelial cells by direct cell contact and by release of cytotoxic substances. It also binds to host plasma proteins, thus preventing recognition by the alternative complement pathway and by host proteinases.

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Epidemiology

Frequency

United States

Trichomoniasis is one of the most common STDs, with approximately 2-3 million infections annually.[1, 2]

International

Worldwide, approximately 180 million infections occur yearly. Prevalence of trichomoniasis was found to range from 5% in patients at family planning clinics to 75% in prostitutes.

Mortality/Morbidity

Trichomoniasis has a high coinfection rate with other STDs. In a study by Wolner-Hanssen et al, gonorrhea was especially noted to be significantly associated with trichomonal infection.[3] Trichomoniasis is also believed to facilitate the transmission of human immunodeficiency virus (HIV).

Trichomoniasis infection in women can range from asymptomatic to an inflammatory state associated with vaginal itching and discharge.

In pregnancy, untreated trichomoniasis may be associated with premature rupture of membranes, low birth weight babies, and posthysterectomy cellulitis.

Sex

Trichomoniasis is observed in both males and females but is more common in women. In males, trichomoniasis may range from asymptomatic infection or carriage to urethritis, prostatitis, or epididymo-orchitis. Women also can be asymptomatic carriers; however, the disease tends to be an acute inflammatory process associated with the features listed below.

Age

Trichomoniasis is more common in adolescent and adult sexually active males and females.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Renee Wilson, MD and Binita R Shah, MD, FAAP to the development and writing of this article.

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