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Trichomoniasis - Coggle Diagram
Trichomoniasis
Diagnosis
Saline Wet Mount Microscopy
Fast point-of-care test, but low sensitivity (50–60%)
Direct visualization of motile, flagellated protozoa
Rapid Antigen Tests / Point-of-Care Immunochromatography
Results in 10–45 minutes
Dipstick or cassette assay (e.g., OSOM Trichomonas Rapid Test)
Culture (T. vaginalis specific media)
Used when NAAT unavailable or for drug-resistance testing
Modified Diamond’s medium or InPouch TV system
Nucleic Acid Amplification Testing (NAAT)
Specimen sources: vaginal swab, endocervical swab, or urine (men/women)
Preferred diagnostic method (highest sensitivity and specificity)
Symptoms
Pruritus and vulvovaginal irritation
Intense genital itching, soreness, and discomfort
Dyspareunia
Pain or discomfort during sexual intercourse
Dysuria
Painful, burning sensation during urination
Malodorous vaginal odor
Distinct foul or "fishy" vaginal scent
Signs
Abnormal vaginal/urethral discharge
Frothy, diffuse, yellow-green secretions
Vulvovaginal mucosal erythema and edema
Local inflammatory swelling and tissue redness
"Strawberry cervix" (Colpitis macularis)
Punctate cervical hemorrhages and mucosal erythema
Pathophysiology
Cytotoxic Effect & Tissue Damage
Disruption of host mucosal barrier
Direct lysis and apoptosis of epithelial cells
Transformation from flagellated form to amoeboid contact form
Transmission & Attachment
Adheres to vaginal or urethral squamous epithelium
Uses surface proteins (adhesins, cysteine proteases) to bind epithelial cells
Parasite enters via sexual contact
Inflammatory & Immune Response
Local mucosal inflammation and erythema ("strawberry cervix")
Secretion of inflammatory cytokines
Recruitment of neutrophils and lymphocytes
Etiology
Causes
Flagellated anaerobic organism
Trichomonas vaginalis (protozoan parasite)
Direct sexual transmission (vaginal intercourse)
Risk Factors
Multiple sexual partners
Previous trichomoniasis infection
Flagellated anaerobic organism
Prognosis
Untreated Progression & Potential Complications
Adverse Pregnancy Outcomes
Preterm labor and delivery
Premature rupture of membranes (PROM)
Low birth weight (<2500 g)
Increased HIV Transmission Risk
2- to 3-fold increased risk of acquiring or transmitting HIV (due to mucosal inflammation and erosion)
General Outcome & Response to Treatment
High Rate of Reinfection
No long-term natural immunity (susceptible to repeated infections)
~17% reinfection rate within 3 months (due to untreated sexual partners)
Excellent Prognosis with Proper Therapy
Rapid clinical symptom resolution (typically within 24–48 hours)
High cure rate (>95%) with appropriate oral nitroimidazole regimen
Treatment
Management Strategies & Clinical Considerations
Concurrent Partner Treatment
Prevention of reinfection ("ping-pong" effect)
Simultaneous treatment of all recent sexual partners regardless of symptoms
Sexual Abstinence
Strict avoidance of sexual intercourse until therapy completion and symptom resolution (minimum 7 days)
Pharmacologic Interventions
Treatment Failure / Allergy Alternatives
Secnidazole (2 g single oral dose)
High-dose oral Metronidazole regimen (2 g daily for 7 days)
First-Line Nitroimidazole Therapy
Oral Tinidazole (2 g single dose alternative)
Oral Metronidazole (500 mg twice daily for 7 days preferred in females)
Inefficacy of Topical Agents
Avoid intravaginal gels/creams (insufficient tissue levels to achieve cure)