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Trichomonas vaginalis Infections

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Sexually Transmitted Infections in HIV-Infected Adults and Special Populations

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Abstract

T. vaginalis, first thought to be a commensal, then a nuisance sexually transmitted infection (STI), is now gaining more recognition as an important contributor to reproductive morbidity and has been associated with HIV acquisition and transmission. T. vaginalis increases recruitment of CD4 cells in vaginal epithelium, disrupts epithelial barrier integrity, and alters vaginal microbiota, increasing risk for HIV transmission. Many persons with T. vaginalis are asymptomatic. Women who have symptoms typically have a vaginal discharge that is frothy, malodorous and yellow-green, as well as dysuria, itching, and/or vulvar irritation. Men who have symptoms exhibit urethritis. While T. vaginalis is not a reportable disease in the United States (US), some risk factors have been identified including increasing age, African American race, incarceration, and HIV infection. HIV-infected women have higher prevalence and recurrence rates of T. vaginalis compared to HIV-uninfected women, thus HIV-infected women should be screened regularly and those who test positive should be rescreened 3 months after treatment. Treatment recommendations are different for HIV-infected women; while the 2 g single dose metronidazole (MTZ) is recommended for HIV-uninfected women, the 7-day multi-dose of 500 mg twice daily is recommended for HIV-infected women. Differences in treatment response may be due to the high rate of comorbidity with bacterial vaginosis (BV), interactions between MTZ and anti-retroviral therapy or other hosts factors. T. vaginalis is generally susceptible to MTZ. HIV-infected persons with T. vaginalis are more likely to shed HIV in genital fluids and treatment of T. vaginalis reduces this HIV shedding, thus T. vaginalis control among HIV-infected persons is also of public health significance.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 242, 1530 3rd Ave. South, 35242, Birmingham, USA

    Christina A. Muzny

  2. Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street Room 2004, 70112, New Orleans, USA

    Patricia Kissinger

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  1. Division of Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA

    Laura Hinkle Bachmann

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Muzny, C.A., Kissinger, P. (2017). Trichomonas vaginalis Infections. In: Bachmann, L. (eds) Sexually Transmitted Infections in HIV-Infected Adults and Special Populations. Springer, Cham. https://doi.org/10.1007/978-3-319-56694-8_7

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