Trichomoniasis (overview) A59.9

Infection with trichomonads (multi-flagellate flagellates). The pathogen is almost always transmitted via sexual contact.

For humans 3 species are pathogenic:

Trichomonas vaginalis: infection of the mucous membrane surfaces in the urogenital tract (worldwide most common sexually transmitted disease; the pathogen can survive in a warm and humid environment for 24 hours. Transmission through infected objects is possible).

Trichomonas tenax: infection of the oral mucosa (especially gingivitis)

Pentatrichomonas hominis: infection of the intestinal mucosa

Infections with Trichomonas vaginalis:

• Trichomonas colpitis
• Trichomonas granuloma
• Trichomonadenurethritis

Trichomonas vaginalis infections occur worldwide. They are among the most common STI pathogens.

Prevalence (worldwide): 250 million infected persons per year. In some tropical countries, trichomonads are the most common pathogens of genital infections.

The prevalence in women is reported as 3%-48%, depending on the population studied. 20% of the women between the ages of 16 and 35 years were infected with trichomonas at least once (Hearn LE et al. 2015).

About 70% of women with gonorrheic infection are co-infected by trichomonads.

In men with non-gonorrheic urethritis (NGU), trichomonads can be detected in 15%.

Affected are mainly adults. Infections in newborns are rare (transmission of the pathogens from mother to child at birth).

Support of the system therapy: Clotrimazole (e.g. Canesten vaginal tablets) and other imidazole derivatives like miconazole (e.g. Daktar cream), Econazole (e.g. Epi-Pevaryl cream) or Econazole vaginal suppositories (e.g. Gyno-Pevaryl 6 Ovula).

Alternative to systemic therapy: Recent studies show that in trichomondanecolpitis an intravaginal combination of metronidazole and miconazole is an effective alternative to systemic therapy.

Notice! Co-treatment of the sexual partner, even in the absence of symptoms (ping-pong effect)!

Agent of choice is Metronidazole (e.g. Clont, Arilin) 1.5-2 g p.o. as ED (healing rate 90%), alternatively 2 times/day 400 mg over 5-7 days (healing rate 95%).

In HIV-positive women a 7-day regime with 2x500mg metronidazole p.o. for 7 days is recommended.

In HIV-positive men, a single dose of 2.0g metronidazole p.o. is sufficient.

Notice! Take Metronidazole before meals on an empty stomach, otherwise delayed absorption and reduced blood levels may occur!

In case of therapy failure repeat administration of 400 mg metronidazole 2 times/day for 5-7 days. In the absence of success, increase the metronidazole dose to 2 g p.o. once/day for 3-5 days. Also effective are tinidazole (e.g. Simplotan Filmtbl.) 2 g p.o. as single dose or nimorazole (e.g. Esclama Filmtbl.) in a dose of 2 g p.o. as single dose.

Metronidazole may also be used during pregnancy.

Smaller positive clinical group results are available with perorally applied extracts of Commiphora molmol (see myrrh below).

1. El-Sherbini GT et al.(2009) Efficacy of two plant extracts against vaginal trichomoniasis. J Egypt Soc Parasitol 39:47-58.
2. Hearn LE et al (2015) Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs. Subst Use Misuse. 50:1501-1509.
3. Kissinger P(2015)Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infect Dis 15:307
4. Korzeniewski K et al (2015) Travel-related sexually transmitted infections. Int Marit Health 66:238-246.
5. Momeni Z et al (2015) Molecular typing of the actin gene of Trichomonas vaginalis isolates by PCR-RFLP in Iran. Exp Parasitol 159:259-263.