Trichomoniasis

Trichomoniasis is an infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or occasionally cause urethritis, vaginitis, including cystitis, epididymitis or prostatitis. The diagnosis is made by direct microscopic examination, dipstick tests or Nukleidsäure amplification assays vaginal secretions or by a culture of the urine or the urethra. Patients and their sexual partners be treated with metronidazole or tinidazole.

T. vaginalis is a flagelliertes, sexually transmitted protozoan that women are more often infected (about 20% of women of reproductive age) than men. Infection can be asymptomatic in both sexes, but is always asymptomatic in men. In men, the organism can persist for long periods without symptoms in the urogenital tract and unknowingly transmitted to sexual partners. Trichomoniasis is the cases of urethritis, which are not caused by gonorrhea or chlamydia, responsible in men for up to 5%.

Trichomoniasis is an infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or occasionally cause urethritis, vaginitis, including cystitis, epididymitis or prostatitis. The diagnosis is made by direct microscopic examination, dipstick tests or Nukleidsäure amplification assays vaginal secretions or by a culture of the urine or the urethra. Patients and their sexual partners be treated with metronidazole or tinidazole. T. vaginalis is a flagelliertes, sexually transmitted protozoan that women are more often infected (about 20% of women of reproductive age) than men. Infection can be asymptomatic in both sexes, but is always asymptomatic in men. In men, the organism can persist for long periods without symptoms in the urogenital tract and unknowingly transmitted to sexual partners. Trichomoniasis is the cases of urethritis, which are not caused by gonorrhea or chlamydia, responsible in men for up to 5%. There is often a co-infection with gonorrhea and other pathogens of STDs. Symptoms and signs in women may be missing the complaints entirely or up to abundant yellow-green, frothy vaginal discharge rich, with soreness of the vulva and perineum dyspareunia and dysuria. Asymptomatic infection may at any time become symptomatic when inflamed vulva and perineum and edema develop in the labia. The vagina wall structures and Zervixoberfläche may have dotted red “strawberry marks”. Also urethritis and possibly cystitis may occur. Although men are usually asymptomatic; nevertheless sometimes urethritis resulting in a urethral discharge that be transient, frothy or pus, or can lead to discomfort and urinary frequency dysuric, usually early in the morning. Often, the urethritis is weak, and results in only a minimal urethral irritation and occasionally urethra to oozing at the meatus, under the foreskin, or both. Epididymitis and prostatitis are rare complications. Diagnosis Microscopic examination, dipstick tests or Nukleidsäure-amplification tests (NAAT) of vaginal culture of urine or urethral swab of men The suspected trichomoniasis in women with vaginitis, possibly in men with urethritis as well as their sexual partners. An urgent suspicion when symptoms after patients and tested for other infectious agents such. As gonorrhea, chlamydia, mycoplasma and ureaplasma treated, persist. In women, the diagnosis is based on clinical criteria and point-of-care (POC) -Testung. One of the following POC tests can be performed: direct microscopic examination of vaginal Immunochromographische flow dipstick tests NAAT Microscopic examination is the simplest method and allows clinicians to test at the same time on trichomoniasis and bacterial vaginosis. Tests for both infections should be done because they cause similar symptoms and / or can be made simultaneously. Vaginal secretions are removed from the posterior fornix. The pH is measured. The secretion samples are then applied to 2 slide; they are washed with 10% KOH solution on a slide (KOH native preparation) and diluted with 0.9% NaCl solution to the other (NaCl native preparation). Means sample the smell KOH wet smear is examined for fishy odor towards caused by amines, which are produced by trichomonas vaginitis or bacterial vaginosis (odor sample). The NaCl native preparation is examined under the microscope immediately for trichomoniasis because they are immobile within minutes on the slide and thus may be difficult to see. Trichomonads are pear-shaped with flagella, often movable and an average of 7-10 microns (about the size of leukocytes), but occasionally up to 25 microns in size. In a trichomoniasis, numerous neutrophils are present. Trichomoniasis is often diagnosed by the organism is seen when a Papanicolaou (Pap) test is performed. Alternatively immunochromographische flow dipstick testing or NAAT that are available from a number of laboratories, are carried out. In women, these tests are more sensitive than microscopic examination or culture. In addition NAAT can be configured to simultaneously detect other organisms or other sexually transmitted diseases such as chlamydia or gonorrhea. Culture of urine or urethral swabs is the only validated test for the detection of T. vaginalis in men. In men, the microscopy of urine is not sensitive and NAAT and dipstick tests have not been strictly assessed; However suggest epidemiological studies that for NAAT urethral swabs are better than urine. As with a diagnosis of any other STD other common STDs such should in patients with trichomoniasis. As gonorrhea and chlamydia infections are excluded. Therapy Oral administration of metronidazole or tinidazole treatment of sexual partners metronidazole or tinidazole 2 g p.o. as a single dose, the disease heals up to 95% of women when sexual partners are treated simultaneously. The effectiveness of single-dose regimens in men is not so clear, so treatment is usually with metronidazole or tinidazole 500 mg po 2 times daily for 5-7 days. If an infection in women is and has been ruled out re-infection of sexual partners, women are first with metronidazole or tinidazole 2 g po once or metronidazole 500 mg 2 times daily treated again for 7 days. When the initial re-treatment regimen fails, metronidazole or tinidazole can be 1 times a day for 5 days effective 2 g. Metronidazole may cause leukopenia, disulfiram-like reactions to alcohol or super infections caused by Candida. A relative contraindication is during early pregnancy, but after the first trimester, it should pose no danger to the fetus. Tinidazole is seen during pregnancy as less secure and therefore not used. Sexual partners should assessed and compared with trichomoniasis tinidazole 2 g are treated in a single dose or metronidazole 500 mg 2 times daily for 5 days and should be screened for other sexually transmitted diseases. If compliance with the follow-up of sexual partners with high probability is difficult to carry out a therapy can be initiated even with sexual partners of patients with a proven trichomoniasis, without the diagnosis was confirmed by the partner. However, this procedure requires at least the consent of the partner. Important points trichomoniasis can be asymptomatic, especially in men, or vaginitis or sometimes cause urethritis. In women, the diagnosis is made by microscopic examination of vaginal secretions, dipstick testing or NAAT. In symptomatic men, the diagnosis is made by culture of urine, urethral swab or possibly NAAT. Patients and their sexual partners are treated with oral metronidazole or tinidazole.

Health Life Media Team

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