ILMU KESEHATAN KULIT DAN KELAMIN

REFERAT

TRICHOMONIASIS

Samanuddin Manawari
10 777 011
SUPERVISOR

: dr. Syahriani, M.Kes, Sp.KK

DEFINITION
Trichomoniasis is an sexually transmitted
disease (STD) that primarily affect the lower
urogenital tract in men and women, could identify
as an critical or chronic condition.

EPIDEMIOLOGY
Most prevalent nonviral STI
Estimated one million cases annually in the U.S. at a
medical cost of $24 million
Prevalence increases with age among women
40%-60% prevalence in female prison inmates and
commercial sex workers

ETIOLOGY
Etiologic agent
Oval shapes within 7m to
23m longer.
It
has
5
flagella
and
undulatting
membrane,
4
flagella in posterior, and 1
flagella covered on anterior.
(can be used to move forwardbackward).
Also have axostyle at its
sitoplasma which had function
as its bone.

RISK FACTORS
Multiple sexual partners
Lower socioeconomic status
History of STDs
Lack of condom use

PATHOGENESIS
For pathogenesis, the organism causes damage when the
Trophozoites attach to immune cells and epithelial cells
And they secrete proteins that cause local inflammation and
cellular destruction
o This results in punctate hemorrhages
o And in women this is manifested as what is called the
strawberry cervix which can be seen on colposcopic
exam

TRANSMISSION
Almost always sexually transmitted.
Females and males may be asymptomatic.
Transmission between female sex partners has
been documented.

CLINICAL MANIFESTATIONS (WOMEN)

May be asymptomatic approximately 70% of the time
Symptoms range from mild to severe:
o Vaginal itching
o Burning with urination
o Production of a thin, frothy malodorous exudate that
can be white, yellow, clear, or green
o Cervical petechiae ("strawberry cervix")
May also infect Skene's glands and urethra, where the
organisms may not be susceptible to topical therapy

CLINICAL MANIFESTATIONS (MEN)

Usually asymptomatic
Urethral or penile pain and irritation
Burning with urination or ejaculation
Penile discharge
Epididymitis
Prostatitis

DIAGNOSIS
Clinical presentation is non-specific infection may be

confused with other STIs, yeast infections, and bacterial

urinary tract infections.
Laboratory testing required
1.

Microscopic examination of unstained or stained

secretions

2.

Culture

3.

Antigen detection assays

4.

Nucleic acid detection assays

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DIAGNOSIS IN MEN
Culture testing of urethral swab, urine, or
semen NAATs
Sex partners of women diagnosed with T.
vaginalis should also be treated regardless of
initial testing

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DIAGNOSIS (Microscopy)
Picture
04.
Wet
preparat and viewed
one thousand zoom in,
trofozoit
trikomonas
vaginalis could be seen
within 4 flagella and
axostyle.

Source: Seattle STD/HIV Prevention Training Center at the University of Washington

DIAGNOSIS (Microscopy)
Picture 05.
Giemsa coloring and
viewed one thousand
zoom
in,
trofozoit
trikomonas
vaginalis
could be seen within 4
flagella and axostyle at
stiplasma posterior with
explicit nucleus

Source: Seattle STD/HIV Prevention Training Center at the University of Washington

DIFFERENTIAL DIAGNOSIS
1. Bacterial Vaginosis
2. Candidiasis

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COMPLICATION

Preterm premature rupture of membranes

Preterm Delivery

Low Birth Weight

Pelvic Inflamation Disease (PID)

Increased risk of acquiring and transmitting

other STIs (HIV)

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MANAGEMENT
RECOMMENDED REGIMEN
Drugs
Metronidazole

Dose
2 g, PO in a single dose

Or
Metronidazole

500 mg, PO twice a day for 7

days

Alternatif recommendations
Tinidazole

2 g, PO in a single dose

WolffK, et al., Trichomonas Vaginalis. Fitzpatricks. Dermatology in General Medicine. 7 th edition

USA: The McGraw-Hill Companies, Inc. 2008

MANAGEMENT IN PREGNANCY
CDC-recommended regimen
o Metronidazole 2 g orally in a single dose
All symptomatic pregnant women should be
treated, regardless of pregnancy stage.

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PARTNER MANAGEMENT
Sex partners should be treated.
Patients should be instructed to avoid sex until they
and their sex partners are cured (when therapy has
been completed and patient and partner are
asymptomatic, about 7 days).

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TREATMENT FAILURE
A common reason for treatment failure is reinfection.
Therefore, it its critical to assure treatment of all sex partners
at the same time.
If treatment failure occurs with metronidazole 2 g orally in a
single dose for all partners, treat with metronidazole 500 mg
orally twice daily for 7 days or tinidazole 2 g orally single
dose.
If treatment failure of either of these regimens, consider
retreatment with tinidazole or metronidazole 2 g orally once a
day for 5 days.

EDUCATION TO PATIENT
1. Discuss individualized risk-reduction plans with the
patient.
2. Discuss prevention strategies such as ;
. Abstinence
. Monogamy
. Use of condoms
. Limiting the number of sex partners.
3. Latex condoms, when used consistently and correctly,
can reduce the risk of transmission of the T. vaginalis
parasite.

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PROGNOSIS
Dubia et Bonam

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Thank you for

the attention