THE TRICHOMONIASIS AND MYCOPLASMA GENITALIUM SYNDROME: TREATMENT AND PREVENTION

TRICHOMONIASIS

Trichomoniasis (trich) is a sexually transmitted infection caused by the single-celled protozoan parasite, Trichomonas vaginalis

 It can affect the vagina, urethra, cervix (the opening to the uterus), or under the foreskin of an uncircumcised penis.

INCIDENCE

•      It is a common Sexually Transmitted Infection (STI) that affects both men and women

•      It is the most common curable STI in young sexually active women.

•      About 7.4 million new cases occur each year worldwide.

INCUBATION PERIOD

It has an incubation period ranging from 5 to 28days

CAUSES

Trichomoniasis is found in certain bodily fluids of someone who has trichomoniasis: semen (cum), pre-cum, vaginal fluid and anal fluid.

•      Trichomoniasis is caused by a one-celled protozoan (Trichomonas vaginalis), a type of tiny parasite that travels between people during sexual intercourse.

RISK FACTORS

•       Having unprotected vaginal sex with an infected person.
•       Sharing sex toys with an infected person
•       A pregnant woman with trichomoniasis can sometimes pass it on to the baby during vaginal childbirth.
•       Multiple sexual partners
•       A history of other sexually transmitted infections
•       A previous episode of trichomoniasis

DIAGNOSIS

•       Physical examination of the genital area
•       Nature of discharges from the vagina and penis of both women and men
•      Rapid antigen tests
•      Nucleic acid amplification test
•       Microscopic examination of discharge from vagina or urethra (wet mounts)
•       Pelvic/vaginal internal exam to check for discharge and inflammation
•       Urine test
•       Cervical smear test
•       Fluorescent antibody assay (staining)
•       Polymerase Chain Reaction (PCR)

LIFE CYCLE OF TRICHOMONAS VAGINALIS

• .      Trichomonas vaginalis trophozoite resides in female lower genital tract and in male urethra and prostate), where it replicates by binary fission
• .      The parasite does not appear to have a cyst form and does not survive well in the external environment.
• .      Trichomonas vaginalis is transmitted among humans, the only known host, primarily via sexual intercourse

PATHOGENESIS

The parasite is passed from an infected person to an uninfected person during sex. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, cervix, or urethra), and in men, the most commonly infected body part is the inside of the penis (urethra). During sex, the parasite is usually transmitted from a penis to a vagina, or from a vagina to a penis, but it can also be passed from a vagina to another vagina.

SIGNS AND SYMPTOMS

•          The only way to know you have trichomoniasis is to get tested.
•          Some people do not have any symptoms and may not know they have it. You can pass on trichomoniasis even if you don’t have any symptoms.
•          Most men will not have symptoms.
•         Most women do not have symptoms or the symptoms may be mistaken for a bladder or vaginal infection.

MEN:

•      Burning after urinations or ejaculation

•      Itching of urethra

•      Slight discharge from urethra

•      Redness or irritation around the tip of the penis

WOMEN:

•      Discomfort with intercourse

•      Itching of the inner thighs

•      Vaginal discharge (thin, greenish-yellow, frothy or foamy)

•      Vaginal itching

•      Vulva itching or swelling of the labia

•      Vaginal odor

•      Pain or bleeding during or after vaginal sex

•      Painful or frequent urination

TREATMENT

The antibiotics, mentronidazole and Tinidazole can be used to treat Trichomoniasis

• One should not drink alcohol for 48 hours afterward
• Avoid intake of alcohol for 48 hours afterward since there may be severe nausea and vomiting
• Avoid sexual intercourse until treatment is complete

NURSING MANAGEMENT

• Avoid sexual intercourse until treatment is complete Avoid vaginal, oral, and anal sex until antibiotic treatment has eliminated the parasite
• Treat all sexual partners to avoid re-infection
• Avoid unprotected sex and Prioritize sexual safety:
• Talk about protection methods with all partners
• Use condoms and other protective measures consistently and properly
• Seek medical advice upon first signs of infection Encourage client to maintain proper personal hygiene by bathing at least twice daily, and frequent changing of underwear due to discharges
• Encourage client to complete antibiotic treatment before resuming sexual activities

PREVENTION

• Make informed decisions. Talk to your partner(s) about STIs and the use of safer sex tools.
• Abstinence or use condoms during sexual intercourse
• Avoid sharing sex toys, be sure to disinfect them or put a new condom on them when a new person uses the toys.
• Get tested for trichomoniasis and other STIs when you or your partner has a new sexual partner. Or, if you have new partners often, get STI testing every 3-6 months. If you ever have symptoms of an STI, get tested right away.
• If you test positive for trichomoniasis, follow your clinician’s instructions for treatment and follow-up

COMPLICATION

Pregnant women who have trichomoniasis may:

• Deliver prematurely
• Have a baby with a low birth weight
• Transmit the infection to the baby as he or she passes through the birth canal
• In women, there is an increased risk of:
• Cervical neoplasia (abnormal cells in the cervix)
• Urinary tract infections (UTIs);
• Infertility
• High risk of getting infected with HIV if you have unprotected sex with an infected person
•  In men, untreated trichomoniasis can reduce fertility and cause swelling in the reproductive tract.

MYCOPLASMA GENITALIUM

•      It is a bacterium that infects the mucous membrane of the urethra, cervix, throat and anus.

AETIOLOGY

Caused by mycoplasma genitalium bacteria

INCUBATION PERIOD

Variable, usually 2 to 35 days

MODE OF TRANSMISSION

It is transmitted by vaginal, anal and oral sex

DIAGNOSTIC INVESTIGATIONS

•      Urine sample for test
•       Urethral swab (a sample of secretions) in men.
•      In women, a cervical swab is taken.
•       PCR (polymerase chain reaction) test

CLINICAL MANIFESTATION

•      Symptoms develop in 1-3 weeks although the incubation period is unknown.

MEN

•      Inflammation of the urethra
•     Burning sensation when passing urine
•     A discharge from the penis
•     Redness at the opening of the penis

WOMEN

•       Pain in the pelvic area
•       Pain during sexual intercourse
•       Abnormal vaginal discharge
•       Inflamed cervix on speculum examination
• 
  

Oral Antibiotics

•        Azithromycin is usually prescribed

PREVENTION

•       Abstinence is the best preventive method
•       The use of condom
•       Have one sexual partner
•       Regular checkup may also be helpful

PATIENT TEACHING

•      Educate patient to avoid sex or use condoms for one week finishing treatment.
•      Encourage patient to go for retesting one month after treatment to be sure that the antibiotics have worked.
•       Encourage patient partner to go for testing.
•       Educate on the cause and prevention of the disease.

COMPLICATIONS

• Infertility in women
• Pelvic Inflammatory Disease
•   Ectopic pregnancy