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Trichomonas vaginalis. Geographical distribution: World wide. * Common sexually transmitted protozoon. * Common at the age of 16-35 (sexually active period). * More pathogenic in women than men. * T. vaginalis is concomitant with other pathogenic organisms. NOTE:
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Trichomonas vaginalis Geographical distribution: World wide * Common sexually transmitted protozoon. * Common at the age of 16-35 (sexually active period) * More pathogenic in women than men *T. vaginalis is concomitant with other pathogenic organisms. NOTE: 1- Suitable pH for the parasite is 4.5 – 6 (low acidic). 2- Rare among young girls / menopause women - parasite requires estrogenized epithelium for survival. 3- High in population at high risk for other venereal diseases & poor feminine hygiene. NOTE: Normal acidity is due to the action of Doderlein bacillus on glycogen content of vaginal epithelial cells producing lactic acid. NOTE: Genus Trichomonashas 3 distinct species: 1- T. hominis which inhabit large intestine & non pathogenic. 2- T. tenax which inhabit oral cavity & commensals. 3- T. vaginalis is the Urogenital pathogenic flagellate
Trichomonas vaginalis Morphology of Trophozoite stage: * Average size 10-15 X 8 µ * Pear shaped • Single vesicular Nucleus anteriorly & a small • antero-lateral cytostome. *Thin axostyle midway crossed by thick parabasal body * Four anterior free flagella and a lateral marginal flagellum with an undulating membrane that reach to about half of the body length. No Cyst stage
Urogenital flagellate: Trichomonas vaginalis axostyle Causes : Trichomoniasis Geog. Distribution : worldwide Habitat: T. vaginalis trophozoite lives: In the vagina and urethra of infected females. In the urethra and prostate of infected males (Never becomes cyst) Transmitted directly during sexual intercourse from infected partner to the other. flagella Nucleus 15 X 8µ
Pathogenesis and Clinical picture In women Trophozoites feed on mucosal surface of vagina and urethra producing sloughing of squamous epithelial cells Asymptomatic (50%) Profuse odourous(foul-smelling) discharge, burning, itching, dyspareunia, frequency of urination and dysuria. On examination: Excessive discharge, diffuse vulvalerythema Vaginal wall inflammation (Strawberry cervix) vagina (Painful sexual intercourse)
Pathogenesis and Clinical picture In men Infection is frequently asymptomatic Symptoms appear when infection involves prostate or higher part of uro-genital tract. Thin discharge, dysuria and nocturia Enlarged tender prostate and epididymitis prostate On examination urethra epididymus
Diagnosis • Microscopic examination of wet film from discharge • Culture of discharge. (modified Diamond’s media) • Detection of T.vaginalis antigen in discharge by: Enzyme immunoassay. Direct fluorescent antibody test. • Detection of DNA of the parasite by Molecular techniques
Treatment Metronidazole + Vinegar vaginal douche Treatment of sexual partner simultaneously Epidemiology and Control Most common between humans at the age of 16-35 High incidence in ladies with deficient feminine hygiene Treatment of the patient and the sexual partner simultaneously Diagnosis and treatment of asymptomatic males Use of condoms to prevent infection
MCQ The trophozoite is the infective stage in: a- Giardia lamblia b- Entamoeba histolytica The protozoan parasite without a cyst stage is: a- Entamoeba histolyica b- Giardia lamblia c- Trichomonas vaginalis d- Balantidium coli c- Balantidium coli d- Trichomonas vaginalis
