Vaginal trichomoniasis: Clinical sciences

Vaginal trichomoniasis is among the most prevalent sexually transmitted infections, or STIs, worldwide. It is caused by the protozoan parasite, Trichomonas vaginalis. Most patients infected with trichomonas have minimal or no symptoms, and untreated infections can last for months to years. Trichomonas infection is associated with an increased risk of both HIV acquisition and HIV shedding, and it increases the risk of pelvic inflammatory disease among HIV-positive patients. Additionally, it has been associated with an increased risk of cervical cancer. In pregnancy, trichomonas infection increases the risk of preterm birth, prelabor rupture of membranes and small for gestational age infants.

Your first step in evaluating a patient who presents with a chief concern suggesting vaginal trichomoniasis is obtaining a focused history and physical exam. This should include a sexual history, such as recent sexual activity or new partners, so be sure to have a private and confidential discussion. Although it might be difficult, you should ask caregivers of young patients to step out of the room for this discussion. Additionally, always consider sexual assault or abuse whenever a young patient has a positive sexual activity history, especially if the patient is a child. If there is abuse going on, you will need to follow up with allegations of abuse in accordance with your State’s law.

Now, keep in mind that trichomoniasis can be spread through vaginal fluids So some practices like sharing of sex toys can cause infection. In addition to sexual history, ask about hygiene practices, such as douching, which can remove some of the bacteria that make up the normal vaginal flora, increasing the risk of overgrowth of infectious pathogens. Although most patients are usually asymptomatic, some may report a malodorous vaginal discharge, vulvar pruritus or irritation, and dysuria.

Physical exam findings include a yellow frothy vaginal discharge; as well as vaginal or cervical erythema with petechiae, which is often referred to as a “strawberry cervix.” Based on these findings, you should suspect vaginal trichomoniasis.

Here is a high-yield fact! In the United States, the prevalence of vaginal trichomoniasis is almost 10 times higher among black patients than non-Hispanic white patients. Some additional risk factors for trichomonas infection include socioeconomic factors like incarceration, having less than a high school education, and poverty.