Trichomoniasis Clinical Presentation

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 5, 2010
 

History

Women

Trichomoniasis symptoms in women range from none to severe pelvic inflammatory disease. Women with trichomoniasis frequently report a frothy yellowish-green vaginal discharge, abnormal vaginal odor, vulvovaginal itching and soreness, dyspareunia (pain during sexual intercourse), and dysuria (pain during urination). However, many infected women experience no symptoms.

Cervicitis due to trichomoniasis is characterized by 2 major signs—purulent discharge in the endocervical canal and easily induced endocervical bleeding.[2] However, it may also be asymptomatic.

T vaginalis infection is one of the top 3 causes of vaginitis.[2] Vaginitis is usually characterized by vaginal discharge, which may be accompanied by vulvar itching, irritation, and odor. The two other most common causes of vaginal discharge are anaerobic bacterial overgrowth of normal flora and candidiasis (infection with Candida albicans).[2]

Men

Trichomoniasis symptoms in men range from none to urethritis complicated by prostatitis. Nongonococcal nonchlamydial urethritis is the most common symptom reported by men with trichomoniasis. Symptoms of urethritis include discharge, dysuria, and urethral pruritus.[2] The discharge may be purulent to mucoid in character. Most symptomatic infections are intermittent and self-limiting. Complications of untreated trichomoniasis include prostatitis, epididymitis, urethral stricture disease, and infertility.

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Physical

Women

  • Purulent or homogenous vaginal discharge and vulvar or vaginal erythema are common.
  • Colpitis macularis, or strawberry cervix, describes a diffuse or patchy macular erythematous lesion of the cervix. This is a specific sign for trichomoniasis but is visible in only 1-2% of cases without the aid of colposcopy. With colposcopy, colpitis macularis is detected in up to 45% of cases.
  • Lower-abdominal tenderness may be present; however, this is described in fewer than 10% of patients. If this occurs, coexisting salpingitis or an intra-abdominal pathology is possible.
  • Coexisting Neisseria gonorrhea infection, candidiasis, and bacterial vaginosis are common and may produce a mixed clinical picture.

Men

  • The findings of trichomoniasis in men on physical examination are generally unremarkable unless the infection is complicated. It may be associated with local inflammatory states, including balanitis and balanoposthitis.
  • Physical findings of epididymitis and prostatitis may also occur.
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Causes

See Pathophysiology.

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Contributor Information and Disclosures
Author

Darvin Scott Smith, MD, MSc, DTM&H,  Adjunct Assistant Professor, Department of Microbiology and Immunology, Stanford University; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H, is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Natalia Ramos  Stanford University, Keck School of Medicine of the University of Southern California

Natalia Ramos, is a member of the following medical societies: American Medical Student Association/Foundation and American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey M Zaks, MD  Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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  2. [Guideline] Centers for Disease Control and Prevention (CDC), Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline].

  3. Soper D. Trichomoniasis: under control or undercontrolled?. Am J Obstet Gynecol. Jan 2004;190(1):281-90. [Medline].

  4. Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet. 1998;351 Suppl 3:2-4. [Medline].

  5. Sobel JD. What's new in bacterial vaginosis and trichomoniasis?. Infect Dis Clin North Am. Jun 2005;19(2):387-406. [Medline].

  6. Miller M, Liao Y, Gomez AM, Gaydos CA, D'Mellow D. Factors associated with the prevalence and incidence of Trichomonas vaginalis infection among African American women in New York city who use drugs. J Infect Dis. Feb 15 2008;197(4):503-9. [Medline].

  7. Patel SR, Wiese W, Patel SC, Ohl C, Byrd JC, Estrada CA. Systematic review of diagnostic tests for vaginal trichomoniasis. Infect Dis Obstet Gynecol. 2000;8(5-6):248-57. [Medline].

  8. Huppert JS. Trichomoniasis in teens: an update. Curr Opin Obstet Gynecol. Oct 2009;21(5):371-8. [Medline].

  9. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. Jan 1993;7(1):95-102. [Medline].

  10. Moodley P, Wilkinson D, Connolly C, et al. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. Feb 15 2002;34(4):519-22. [Medline].

  11. Grodstein F, Goldman MB, Ryan L, et al. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. Jun 15 1993;137(12):1353-60. [Medline].

  12. Shafir SC, Sorvillo FJ, Smith L. Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans. Clin Microbiol Rev. Jan 2009;22(1):37-45, Table of Contents. [Medline].

  13. Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: an observational study. J Womens Health (Larchmt). Apr 2009;18(4):493-7. [Medline].

  14. [Guideline] ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. May 2006;107(5):1195-1206. [Medline].

  15. Burtin P, Taddio A, Ariburnu O, et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. Feb 1995;172(2 Pt 1):525-9. [Medline].

  16. Guenthner PC, Secor WE, Dezzutti CS. Trichomonas vaginalis-induced epithelial monolayer disruption and human immunodeficiency virus type 1 (HIV-1) replication: implications for the sexual transmission of HIV-1. Infect Immun. Jul 2005;73(7):4155-60. [Medline]. [Full Text].

  17. Nanda N, Michel RG, Kurdgelashvili G, et al. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. Feb 2006;4(1):125-35. [Medline].

  18. Radonjic IV, Dzamic AM, Mitrovic SM, Arsic Arsenijevic VS, Popadic DM, Kranjcic Zec IF. Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol. May 1 2006;126(1):116-20. [Medline].

 
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Trichomonas vaginalis on a saline wet mount at 40X on the microscope. Several motile parasites transit through the field, surrounded by white blood cells and squamous epithelial cells.
 
 
 
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