Trichomonads infection

Clemens Gödel is a freelancer for the medical team.

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Trichomonas infection (trichomoniasis) is one of the most common sexually transmitted diseases of the urogenital tract worldwide. It mainly affects women. In most cases, the infection is symptom-free. The treatment is carried out with a short dose of antibiotics. However, caution should be exercised during pregnancy. Find out everything you need to know about the symptoms, diagnosis and treatment of trichomoniasis.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A59

Trichomonas infection: description

Trichomoniasis or trichomonads infection is an infection with Trichomonas vaginalis. This is a parasite that belongs to the group of protozoa. Protozoa are single-celled living things. Other protozoa are the malaria pathogens and the pathogens of toxoplasmosis. Trichomonas vaginalis has a pear-like shape and has thread-like structures on its surface that are used for locomotion.

In women, the protozoon can most often be found in the vagina, the urethra and the so-called paraurethral glands. Trichomonas can cause vaginal and urethral and cervical infections. In men, Trichomonas vaginalis is particularly comfortable in the urethra. Apart from humans, Trichomonas vaginalis has no other reservoir where it can survive for a long time. Outside the human body, the parasite usually dies quickly - with the exception of moist objects and water. However, contaminated water is not of great importance from an epidemiological point of view.

The infection with Trichomonas vaginalis can in part only be estimated because the disease is not notifiable. It is estimated that in industrialized countries between five to ten percent of women and around one percent of men are affected. Around 52 new infections per 1000 inhabitants occur in Western Europe each year. Because the infected are often free of symptoms, Trichomonas vaginalis can spread quickly.

In addition to bacterial vaginosis and fungal infections (candidiasis) of the genital tract of women, trichomonas infection is one of the most common causes of complaints in the vagina. A trichomonad infection should be discovered early and treated. Failure to do so can lead to complications during pregnancy. It also eases other sexually transmitted diseases, which can often result in multiple infections.

Trichomonads infection: symptoms

In up to 85 percent of the cases, the infection does not cause any clear symptoms of trichomonas. In all other cases, symptoms appear 2 to 24 days after the trichomonas infection. The most common trichomonas symptoms are vaginal discharge, excruciating itching, painful urination or an unpleasant smell. The vaginal discharge occurs as a trichomonad symptom in more than three out of four cases. The discharge is often offensive, green, and foamy. In addition, sexual intercourse is often painful. Non-specific abdominal complaints can also be associated with a trichomonad infection.

Trichomonads in men rarely cause symptoms. The signs are unspecific and manifest themselves as discomfort when urinating and urethral pain. A small amount of discharge from the urethra can also occur. In rare cases, the glans is inflamed. However, the intensity and severity is usually much lower than that of women. In the case of repeated and resistant complaints, however, a trichomonad infection should always be considered in men.

Trichomonas infection: causes and risk factors

Trichomonads infection is one of the so-called sexually transmitted diseases. This means that in almost all cases the infection with trichomonads happens during sexual intercourse. As a result, the infection is mostly limited to the vagina and lower urinary tract. But trichomonads can also be transmitted through contact with infectious body fluids, for example during petting or through shared towels. Since the majority of those infected show no symptoms, the transmission often happens unconsciously. The colonization of the urogenital tract with Trichomonas vaginalis and attachment to the body cells lead to an inflammatory reaction. These cells are mainly damaged and destroyed by soluble substances excreted by Trichomonas vaginalis.

During the birth process, a trichomonas infection in the mother can be transmitted to the child. However, this only happens 2 to 17 percent of the time.

Infection in prepubescent girls is rare, but if an infection with Trichomonas does occur, any sexual contact that has taken place should be checked.

Risk factors

Trichomonads infection is relieved by a lack of estrogen in the vagina, damage to the vaginal flora and foreign bodies such as forgotten tampons. Bacterial vaginosis also doubles the risk of trichomoniasis. In addition, certain diseases such as diabetes mellitus, immunosuppression, pregnancy, HIV infection or tumors increase the susceptibility to trichomoniasis. Statistically speaking, trichomonads infections occur more frequently with low socio-economic status, changing sexual partners and poor hygiene. People affected by other sexually transmitted diseases often also have an existing trichomonas infection. Conversely, trichomoniasis makes you more susceptible to HIV infection.

Prevent

To protect against trichomonas infection, a condom should be used during sexual intercourse. Good intimate hygiene is the basis of effective infection prophylaxis. You should also exercise caution when bathing. After swimming, you should quickly put on dry clothes.

Trichomonads infection: examinations and diagnosis

The specialist for trichomonas infection is the gynecologist for women and the urologist for men. During the initial examination, the following questions, among others, are asked:

• Are you known to have infections of the urogenital region?
• Have you observed unusual discharge from the vagina / penis?
• Do you have painful urination or sexual intercourse?
• Have you had frequently changing sexual partners recently?

At the beginning, the genitals and, if possible, the urinary tract are examined. Swelling, redness, and other signs of inflammation are the first signs of an existing infection. A detailed examination of the female genitals through a colposcopy with a special examination microscope reveals further signs of inflammation and irritation. The examination is normal for up to 15 percent of infected women.

To determine whether a trichomonas infection has actually occurred, a smear from the vagina or vaginal secretion is examined under the microscope. The protozoan Trichomonas can also be detected from urethral secretions or urine. Trichomonads can also be stained for viewing under a microscope, but this requires experience. However, the best way to detect infection is to try to cultivate the trichomonads from secretions or urine. There is also a molecular biological method (PCR) that can be used to detect the DNA.

When diagnosing trichomoniasis, one should also look for other existing sexually transmitted diseases, especially HIV. It is also important to ask about further sexual contacts in order to treat partners if necessary.

Trichomonas infection: treatment

If a trichomonas infection has been proven, one should always treat the partner as well. In most cases, a single dose of two grams of the antibiotic metronidazole is sufficient. Another therapeutic option is to give four lower-dose tablets twice with an interval of six hours on the first day and one tablet the next morning. Alternatively, especially in the case of repeated trichomonas infections, 500 grams of metronidazole can be prescribed twice a day for five to seven days.

Local administration of metronidazole in the form of a gel is not recommended, as it often affects glands or other areas that are not accessible to local therapy. Those affected should remain sexually abstinent until the end of the trichomonads therapy.

If these therapy suggestions are used, there is a high probability of a successful recovery. Spontaneous healing without trichomonads therapy is possible in up to 20 percent. Alcohol should not be consumed during treatment - this applies up to 48 hours after taking the last tablet.

Metronidazole cannot be used carelessly in an existing pregnancy. Use should be carefully considered, especially in the first trimester of pregnancy. There are a number of studies on the use of metronidazole, most of which do not provide any evidence of negative consequences of treatment for pregnant women. In pregnant women, however, high single-dose therapy should rather not be carried out.

If the trichomonads symptoms persist or recur despite therapy, the trichomonads diagnosis should be repeated and the therapy then intensified if necessary.

Trichomonads infection: disease course and prognosis

Trichomoniasis can be treated well and therefore belongs to the group of curable sexually transmitted diseases. However, since trichomonads often do not cause any symptoms, the disease remains unnoticed for a long time - but can also heal during this time. Untreated trichomonas infection can affect the course of pregnancy. Important complications are premature birth and low birth weight. In rare cases, a trichomonas infection can lead to an ascending inflammation of the fallopian tubes. In men, this can lead to prostate inflammation. In addition, there is the increased susceptibility to other sexually transmitted diseases. For these reasons, among other things, rapid trichomonads therapy is necessary, especially for groups at risk of sexual infections. After a trichomonas infection, there is no protection against a new disease.

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