Trichomomal Vaginitis is the most common vaginitis in the childbearing period.
Causative Organism and Transmission-
It is caused by a protozoan called Trichomonas vaginalis which is 20 micrometer X 10 micrometer pear shaped parasitic organism. It has 4 anterior flagellae and a spear-like protrusion at the other end . It is covered by an undulating membrane on its anterior 2/3rd. It is actively motile organism.
Predominantly transmitted by sexual contact. Urethra and prostrate of Male ( men) harbors the trichomonas and may even be transmitted via toilet articles from women-women or via examining gloves of a health personnel.
Incubation period is 3-28 days.
25% of women in reproductive age group have asymptomatic infection. When local defence mechanisms are impaired during menstruation, following illness or having sex after having a baby, the pH of vagina is raised to 5.5-6.5. Trichomonas infectio
n can thus occur at this pH. They produce inflammatory
75% organism can be isolated from Urethra, Skene’s tubules and Bartholin’s gland .
- There is profuse, offensive vaginal discharge ( usually following menstruation)
- Itching and Irritation mild to severe around the genitalia
- Urinary symptoms like dysurea ( painful urination), frequency of urination can occur
- History of similar attacks in past may be derieved
- Up to one-third of infected women have no symptoms
- The majority of infected men have no symptoms
- Urethral discharge,Pain with urination – dysurea
- Pain and swelling in the scrotum
- Thin, froathy, greenish to yellow, offensive discharge per vaginum
- The vulva is inflamed, Evidence of pruritis like scratch marks, abrasions, redness may be seen.
- Per vaginal examination may be painful, red inflamed walls with punctuate hemorrhages can be seen. Similar lesions may also be seen over the PortioVaginalis part of Cervix and may be “ Strawberry” appearance.
- Identification is done by Hanging drop preparation. Motile organisms may be found. If negative on repeated examinations, culure should be done for confirmation.
- Culture of the discharge collected by swabs in Kupfberg’s or Fein Whittington medium.
D/D– Gonorrhea, Candidiasis.
- Metronidazole is quiet effective for the treatment. 200mg TDS PO for 1 week is given. Partner should be treated at the same time and for same duration. Barrier methods of contraception should be used until cured. A second course of therapy may be required if the symptoms persist after 7 days. Upto 3 cycles in 3 months may be needed.Use of Metronidazole in Pregnancy can cause teratogenic effects on fetus ( congenital malformations).
- Clotrimazole pessaries 100mg for consecutive 6 nights. It is preferred during pregnancy and lactation. It treats candidiasis as well.