Faculty of Dentistry

Jordan University
Dr Mohammad Al-Tamimi, MD, PhD
Introduction
Trichomonas vaginalis )T. Vaginalis ( is a flagellated
protozoa which infect humans and animal
A sexually transmitted disease (STD) transmitted
by sexual contact
T. Vaginalis is the etiological agent of trichomoniasis.
In females the organism inhabits the vagina and
urethra
In males it is found in the urethra, prostate or,
seminal vesicles.
Epidemiology
Worldwide, the annual incidence of trichomoniasis is
about 170 million cases.
In USA approximately 8 million new cases of
trichomoniasis occur annually. The incidence of
trichomoniasis in Europe is similar to that in the United
States. Sex shit!!!
In Africa, the prevalence of trichomoniasis may be
much higher but we dont have numbers for this
Just know it is common thats it
Incidnce in females more
Specially during pregnancy
T. Vaginalis trophozoite
The life cycle consist only of a
trophozoite stage only which is
transmitted by direct contact during
sexual intercourse
Fg=flagella 3-4 out of basal body
Bb=basal body
Nu=nucleus
Ax=axostyle
um=undulating membrane (special and
helps in moving)
Cy=cytostomal groove
Cs=costa
Life cycle
Flagella are found in the genital tract.
Transmission: during dealings with contaminated
matters (clothes, cotton, bathroom, ..etc). !!!!!!
Pathogenesis
Natural flora (bacteria ) keep the pH of the vagina at
4-4.5 and ordinarily this discourages infections.
T. vaginalis can survive at a low pH.
Females get a disintegration of vaginal epithelial
lining.
Once established it causes a shift toward alkalinity (pH
5-6) which further encourages its growth.
Changes in vaginal pH induce erosion of normal
mucosa in women and facilitate bacterial infections
Clinical Manifestations
T. vaginalis causes different manifestation in men and
women.
Women are more likely to exhibit symptoms which tend to
persist longer
Incubation period is 4-28 days. Max is 4 weeks to diagnose
this shit!
Can be asymptomatic, to mild or moderate irritation, to
extreme vaginitis
10 - 50%: asymptomatic
The commonest symptoms: vaginal discharge, vulval itching,
dysuria, or offensive odor , rare abdominal discomfort
Vaginal discharge: up to 70% - varying in consistency from
thin and scanty to profuse and thick; the classical discharge of
frothy (thick) yellow occurs in 10-30% of women
 In male
50-90% are asymptomatic
mild dysuria or pruritus I,e severe itching of skin
minor urethral discharge
Physical Examination
Pelvic examination: Inspection of external genitalia.
Speculum examination: insertion and visualization of
vagina and cervix, obtaining swabs and slide
specimens.
Findings: Profuse, frothy discharge, yellow-greenish in
color , foul odor, Patchy vaginal erythema, strawberry
cervix and easily induced endocervical bleeding
Complications
The infection is highly associated with the presence of
other sexually transmitted infections, including
gonorrhea, chlamydia, and HIV. Sooo check for all!!!!
Trichomoniasis is also associated with adverse
pregnancy outcomes, infertility, postoperative
infections, and cervical neoplasia.
There is a tendency to explain stillbirths, spontaneous
abortions, morbidity to women who have vaginitis.
Diagnosis
Specimens: vaginal discharge, urine sediment, prostatic
secretion
Vaginal pH
Whiff test

Wet mount ( visualize under

microscope look for und. Membr.)
Culture very rare
Direct immunoflouresence assay
Polymerase chain reaction very rare
Evaluation for other STDs sometimes
Wet mount smear
A wet mount preparation of discharge from the patient
should be examined microscopically as a first step in
diagnosing T. vaginalis infection.
The presence of typical pear-shaped trophozoites,
usually 7 to 23 m in length, with "bobbling motility
and, on careful examination, the wave like movement
of the undulating membrane, are usually sufficient to
identify T vaginalis.
Potassium hydroxide amine test
(Whiff test) :
Upon application of 10% potassium hydroxide (KOH)
to a vaginal swab sample, a fishy odor is released,
which can suggest trichomoniasis or bacterial
vaginitis.
Old test!!
Treatment and prevention
Metronidazole is effective in both males and females.
Personal hygiene and the use of condoms are helpful.