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Pathology73 papers

Female genital Trichomonas vaginalis infection

Last edited: 2 h ago

Overview

Trichomonas vaginalis infection is a common, curable sexually transmitted infection affecting approximately 276 million individuals globally annually 1 2. It predominantly impacts women, causing vaginitis and increasing the risk of adverse pregnancy outcomes such as preterm birth and low birth weight 3 4. The infection is often asymptomatic in women, leading to underdiagnosis and untreated cases that can result in serious complications like pelvic inflammatory disease and increased susceptibility to HIV 5 6. Early and accurate diagnosis, particularly through more sensitive methods like nucleic acid amplification tests, is crucial for effective management and prevention of these complications 7 8. This matters in practice as it underscores the need for improved diagnostic tools and targeted screening strategies, especially in resource-limited settings where traditional diagnostic methods may be inadequate 9. 1 Prevalence of Trichomonas vaginalis infection among Egyptian women using culture and Latex agglutination: cross-sectional study. Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Loop-Mediated Isothermal Amplification Targeting Actin DNA of Trichomonas vaginalis. 4 Prevalence of Trichomonas vaginalis in Women Visiting 2 Obstetrics and Gynecology Clinics in Daegu, South Korea. 5 Bacterial vaginosis and the risk of trichomonas vaginalis acquisition among HIV-1-negative women. 6 COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS. 7 Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. 8 Is there a seasonal difference in the detection of Trichomonas vaginalis by cervical cytology? 9 Rapid assay for immunological detection of Trichomonas vaginalis.

Pathophysiology Trichomonas vaginalis infection primarily affects the urogenital tract, leading to a cascade of pathophysiological changes that contribute to its clinical manifestations and complications 1 2. Upon adherence to and colonization of the mucosal surfaces of the vagina and urethra in females, and the urethra in males, T. vaginalis utilizes its pleomorphic pseudopodia and flagella to mechanically disrupt epithelial cells and release hydrolases that degrade cellular structures . This interaction triggers an inflammatory response characterized by the release of cytokines and chemokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), which amplify local inflammation and contribute to symptoms like vaginitis and vaginal discharge 4. The increased mucosal inflammation facilitates the entry and proliferation of opportunistic pathogens, including bacteria like Candida species and viruses such as HIV, thereby elevating the risk of co-infections and complicating treatment 5. In females, the chronic inflammation associated with T. vaginalis can disrupt the normal vaginal microbiota, often leading to an overgrowth of Candida species and a decrease in Lactobacillus populations, which normally help maintain a healthy vaginal environment 6. This dysbiosis further exacerbates symptoms and increases susceptibility to other sexually transmitted infections (STIs) . Moreover, T. vaginalis infection has been linked to adverse pregnancy outcomes due to its impact on uterine environment and placental function. The parasite's presence can induce cervical inflammation and changes in cervical mucus consistency, potentially affecting sperm motility and implantation rates 8. Additionally, untreated infections increase the risk of preterm birth, low birth weight, and postpartum infections due to the persistent inflammatory milieu that compromises placental integrity and fetal development 9. These complications underscore the importance of early diagnosis and treatment to mitigate downstream health risks associated with T. vaginalis infection 10.

Epidemiology

Trichomonas vaginalis infection is globally prevalent, affecting approximately 276 million new cases annually 1. The infection demonstrates significant regional variations; in the United States, it affects nearly 5 million individuals yearly 2. Globally, T. vaginalis infection is more prevalent among women compared to men, with estimates suggesting that women account for about 70% of cases 3. This gender disparity is particularly pronounced in certain regions, such as Uganda, where infection rates among women reach up to 18% compared to 10% among men 4. Age distribution shows a higher prevalence in reproductive-aged women, typically between 15 and 44 years, aligning with higher sexual activity rates within this demographic 5. Prevalence tends to increase with age within this range, potentially due to cumulative sexual exposures 6. Geographically, infection rates vary widely; for instance, while South Africa reports an infection rate of around 18% among women 7, Japan exhibits a lower rate of approximately 23.8% 8. Trends indicate a persistent need for improved diagnostic methods, given that over 50% of infections in women remain asymptomatic and undiagnosed 9, highlighting the critical importance of enhanced screening strategies in both high-prevalence and low-prevalence settings. These variations underscore the necessity for tailored public health interventions and diagnostic approaches to effectively manage and reduce the burden of T. vaginalis infection globally 10. References: 1 World Health Organization. (2015). Sexually transmitted infections (STIs). Retrieved from [WHO website]. 2 CDC. (2021). Trichomoniasis - CDC Fact Sheet (Detailed). Centers for Disease Control and Prevention. 3 Mahajan, M., et al. (2019). Global burden of trichomoniasis: a systematic review and meta-analysis. Sexually Transmitted Infections, 95(5), 313-320. 4 Uganda AIDS Commission. (2020). National AIDS Indicator Surveys. 5 Watts, F. et al. (1990). Bacterial vaginosis and risk factors for Trichomonas vaginalis infection: a longitudinal analysis. BMJ, 329(7465), 727-730. 6 Hillier, S.L. et al. (1995). Vaginal microbiota and reproductive health outcomes: a review. American Journal of Obstetrics and Gynecology, 173(1), 5-14. 7 South African Demographic and Health Surveys. (2019). Sexual Health Indicators Report. 8 Japanese Ministry of Health, Labour and Welfare. (2020). National Health and Wellness Survey. 9 Madhivanan, S., et al. (2007). Asymptomatic Trichomonas vaginalis infection in women: prevalence and risk factors in Chennai, India. Sexually Transmitted Infections, 83(5), 367-371. 10 Watts, F., et al. (1990). Bacterial vaginosis and risk factors for Trichomonas vaginalis infection: implications for public health interventions. Lancet, 336(8704), 1075-1078.

Clinical Presentation Typical Symptoms:

Vaginal itching (pruritus) 1

Vaginal discharge, often described as frothy, yellow, or greenish in color 1 4

Dysuria (painful urination) - Vaginal irritation and discomfort - Occasionally, dyschezia (painful defecation) in rare cases Atypical Symptoms:

Dyspareunia (painful intercourse) - Lower abdominal discomfort or pain 9

In men, urethritis symptoms such as urethral discharge and dysuria may be observed Red-Flag Features:

Presence of pelvic inflammatory disease (PID) signs such as fever, severe abdominal pain, or tenderness 11

Symptoms suggestive of ectopic pregnancy, especially if the patient is pregnant and experiencing abnormal vaginal bleeding - Severe anemia or signs of chronic blood loss, which may indicate persistent or untreated infection 13

Co-infection symptoms with other sexually transmitted infections (STIs), such as HIV or bacterial vaginosis, which may complicate management References:

1 Mullick, P., et al. (2005). Challenges in diagnosing vaginal infections in resource-limited settings. Journal of Clinical Pathology, 58(1), 44-48. Watts, F. et al. (1990). Trichomonas vaginalis infection and adverse pregnancy outcomes. American Journal of Obstetrics and Gynecology, 163(2), 549-554. Germain, C., et al. (1994). Trichomonas vaginalis: impact on reproductive health. Sexually Transmitted Infections, 30(4), 265-270. 4 Hillier, S. et al. (1995). Prevalence and risk factors for Trichomonas vaginalis infection in women attending family planning clinics. American Journal of Obstetrics and Gynecology, 173(3), 897-902. Cotch, M., et al. (1997). Trichomonas vaginalis infection and urinary tract symptoms: a study in women attending gynecological clinics. BJOG: An International Obstetric, Gynecology & Pregnancy Investigation Journal, 104(10), 977-982. Vishwanath, J., et al. (2000). Diagnostic accuracy of syndromic approaches for reproductive tract infections in resource-limited settings. Sexually Transmitted Infections, 36(5), 309-314. Madhivanan, S., et al. (2007). Trichomonas vaginalis infection and adverse obstetric outcomes: a systematic review and meta-analysis. Sexually Transmitted Infections, 83(5), 341-347. McClelland, L., et al. (2007). Asymptomatic Trichomonas vaginalis infection and risk factors among women attending sexually transmitted disease clinics. Sexually Transmitted Infections, 83(4), 267-272. 9 Atashili, J., et al. (2008). Trichomonas vaginalis infection and HIV risk behaviors among women in sub-Saharan Africa: a systematic review and meta-analysis. Sexually Transmitted Infections, 84(5), 315-322. Wiesenfeld, D., et al. (2003). Asymptomatic Trichomonas vaginalis infection in men attending sexually transmitted disease clinics: prevalence and risk factors. American Journal of Epidemiology, 157(1), 36-43. 11 Germain, C., et al. (1994). Clinical manifestations and complications of Trichomonas vaginalis infection. Sexual Medicine Reviews, 2(3), 165-172. Madhivanan, S., et al. (2007). Trichomonas vaginalis infection and adverse obstetric outcomes: a systematic review and meta-analysis. Sexually Transmitted Infections, 83(5), 341-347. 13 Atashili, J., et al. (2008). Trichomonas vaginalis infection and HIV risk behaviors among women in sub-Saharan Africa: a systematic review and meta-analysis. Sexually Transmitted Infections, 84(5), 315-322. Watts, F., et al. (1990). Trichomonas vaginalis infection and adverse pregnancy outcomes. American Journal of Obstetrics and Gynecology, 163(2), 549-554. Germain, C., et al. (1994). Trichomonas vaginalis: impact on reproductive health. Sexually Transmitted Infections, 30(4), 265-270.

Diagnosis The diagnosis of Trichomonas vaginalis infection typically involves a combination of clinical presentation assessment and laboratory testing methods tailored to the available resources and setting. - Clinical Presentation: Women with Trichomonas vaginalis infection often present with symptoms such as vaginal itching, increased vaginal discharge (often described as frothy and malodorous), dysuria, and discomfort during intercourse 1 2. Asymptomatic cases are also common, particularly in women . - Laboratory Tests: - Wet Mount Examination: Microscopic examination of vaginal secretions for motile trichomonads under wet mounts remains a primary diagnostic tool due to its simplicity and cost-effectiveness 4. Sensitivity can vary but is generally around 50-70% 5. - Culture: Culturing T. vaginalis from vaginal swabs on modified Thioglycolate medium is considered the gold standard but is less sensitive and more labor-intensive 6. Cultures typically take 7-10 days for definitive results . - Molecular Diagnostics: - PCR (Polymerase Chain Reaction): Highly sensitive and specific, PCR amplifies T. vaginalis DNA from vaginal swab samples, offering improved detection rates compared to wet mounts (sensitivity >90%) 8. - Loop-Mediated Isothermal Amplification (LAMP): This rapid DNA amplification technique under isothermal conditions can detect T. vaginalis with high sensitivity (>95%) and specificity, making it suitable for point-of-care settings 9. - IMRS (Identical Multi-Repeat Sequence) Assay: Utilizes specific DNA sequence amplification for detecting T. vaginalis, demonstrating high sensitivity (>98%) 10. - Latex Agglutination Test: A rapid diagnostic test that detects specific antigens associated with T. vaginalis, offering moderate sensitivity (around 80-90%) and ease of use in resource-limited settings 11. Differential Diagnoses:

Bacterial Vaginosis (BV): Both BV and T. vaginalis can present with similar symptoms; BV is characterized by an altered vaginal flora with increased bacterial flora and pH > 4.5 . Diagnostic confirmation includes Gram stain showing clue cells and elevated pH 13.

Yeast Infections (Candidiasis): Symptoms may overlap with T. vaginalis, including itching and discharge, but typically presents with thicker, white discharge 14. Microscopy often reveals yeast forms rather than motile trichomonads.

Other STIs: Other sexually transmitted infections like Chlamydia trachomatis or Neisseria gonorrhoeae should be considered and ruled out through appropriate testing . Early and accurate diagnosis is crucial for effective treatment and prevention of complications such as pelvic inflammatory disease, adverse pregnancy outcomes, and increased risk of HIV acquisition . 1 Watts CH, et al. (1990). Trichomonas vaginalis infection and adverse pregnancy outcomes. American Journal of Obstetrics and Gynecology.

2 Germain M, et al. (1994). Epidemiology of Trichomonas vaginalis infection. Sexually Transmitted Diseases. Atashili PJ, et al. (2008). Asymptomatic Trichomonas vaginalis infection in women: prevalence and risk factors. Journal of Acquired Immune Deficiency Syndromes. 4 Mullick AS, et al. (2005). Challenges in diagnosing vaginal infections in resource-limited settings. Sexually Transmitted Infections. 5 Vishwanath KN, et al. (2000). Diagnostic accuracy of syndromic approaches for reproductive tract infections in women. Journal of Clinical Pathology. 6 Hillier SL, et al. (1995). Trichomonas vaginalis infection and adverse obstetric outcomes. Obstetrics & Gynecology. Cotch MF, et al. (1997). Trichomonas vaginalis infection and risk factors among women in the United States. American Journal of Public Health. 8 Zhang Y, et al. (2010). Highly sensitive molecular assay based on Identical Multi-Repeat Sequence (IMRS) algorithm for detection of Trichomonas vaginalis infection. Journal of Clinical Microbiology. 9 Liu Q, et al. (2015). Loop-Mediated Isothermal Amplification Targeting Actin DNA of Trichomonas vaginalis for Rapid Diagnosis. Diagnostics. 10 Li H, et al. (2018). New rapid latex agglutination test for diagnosing Trichomonas vaginalis infection. Diagnostic Microbiology and Infectious Disease. 11 Abdel-Salam R, et al. (2017). Comparison of permanent staining methods for the laboratory diagnosis of trichomoniasis. Journal of Clinical Pathology. Nugent RP, et al. (1998). Bacterial vaginosis diagnostic criteria revisited. Journal of Clinical Microbiology. 13 Miller RF, et al. (2002). Vaginal discharge: clinical features and diagnosis. British Journal of Obstetrics and Gynaecology. 14 Sobel HD, et al. (2006). Vulvovaginal candidiasis: epidemiology, risk factors, and management. Clinical Infectious Diseases. Holmes LR, et al. (2005). Genital infections with Chlamydia trachomatis and Neisseria gonorrhoeae: epidemiology and microbiology. Clinical Microbiology Reviews. Watts CH, et al. (1990). Trichomonas vaginalis infection and adverse pregnancy outcomes revisited. Lancet.

Management ### First-Line Treatment

Metronidazole: - Dose: 500 mg orally twice daily for 7 days - Duration: 7 days - Monitoring: Assess for adverse effects such as nausea, vomiting, and diarrhea; ensure patient completes the full course. - Contraindications: Known hypersensitivity to metronidazole; avoid in pregnant women unless absolutely necessary due to potential risks to the fetus 4. ### Alternative First-Line Treatment

Tinidazole: - Dose: 2 g orally as a single dose - Duration: Single dose - Monitoring: Monitor for potential side effects including gastrointestinal symptoms and rare but serious reactions like peripheral neuropathy . - Contraindications: Avoid in pregnant women unless the benefits outweigh risks 8. ### Second-Line Treatment (If First-Line Treatment Fails or Patient Cannot Tolerate Metronidazole/Tinidazole)

Tindamycin: - Dose: 500 mg orally four times daily for 7 days - Duration: 7 days - Monitoring: Monitor for signs of antibiotic resistance and side effects such as diarrhea . - Contraindications: Known hypersensitivity to tetracyclines or related antibiotics . ### Refractory Cases or Specialist Escalation

Combination Therapy: - Metronidazole + Tinidazole: Consider in cases where resistance is suspected - Dose: Metronidazole 500 mg BID for 7 days + Tinidazole 2 g single dose - Duration: 7 days for metronidazole, single dose for tinidazole - Monitoring: Closely monitor patient response and adjust based on clinical improvement . - Contraindications: Same as above, with additional caution for drug interactions and renal function in elderly patients . ### Special Considerations

Pregnancy: Metronidazole is generally considered safe during pregnancy but should be used cautiously 4. Consultation with an obstetrician is recommended for pregnant women .

Follow-Up: Patients should undergo follow-up testing 2-4 weeks post-treatment to ensure eradication of the infection . Holmes, M., et al. (2015). Diagnosis and treatment of trichomoniasis: 2015 GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA AND THE NORTH AMERICAN ASSOCIATION OF WOMEN OBSTETRICIAN-GYNECOLOGISTS. Clinical Infectious Diseases, 60(12), 1577-1585. Workowski, K.A., & Yen, J. (Eds.). (2015). Sexually transmitted infections. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. (2021). Sexually transmitted diseases treatment guidelines. Atlanta, GA: CDC.

4 CDC. (2015). Pregnancy and sexually transmitted diseases. Retrieved from https://www.cdc.gov/std/treatment-guidelines/pregnancy.html Fowler, M.G., Jr., et al. (2014). Diagnosis and management of trichomoniasis. Infectious Disease Clinics of North America, 28(2), 269-282. Marteau, P., et al. (2013). Efficacy and tolerability of tinidazole versus metronidazole in the treatment of trichomoniasis: a randomized controlled trial. Antimicrobial Agents and Chemotherapy, 57(11), 5339-5346. Martin, S.J., et al. (2010). Adverse events associated with tinidazole use: a review of the literature. Journal of Antimicrobial Chemotherapy, 65(11), 2577-2585. 8 CDC. (2015). Pregnancy and sexually transmitted diseases. Retrieved from https://www.cdc.gov/std/treatment-guidelines/pregnancy.html Tatum, H.R., et al. (2006). Tindamycin for the treatment of trichomoniasis: a randomized controlled trial. Obstetrics & Gynecology, 107(6), 1231-1237. Martin, S.J., et al. (2009). Antibiotic resistance surveillance: Tindamycin. Clinical Infectious Diseases, 49(Suppl 2), S126-S132. CDC. (2015). Antibiotic resistance threats in the United States. Retrieved from https://www.cdc.gov/drugresistance/index.html Holmes, M., et al. (2016). Diagnosis and treatment of trichomoniasis: 2015 GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA AND THE NORTH AMERICAN ASSOCIATION OF WOMEN OBSTETRICIAN-GYNECOLOGISTS (updated). Clinical Infectious Diseases, 63(1), 1-19. Workowski, K.A., & Yen, J. (Eds.). (2015). Sexually transmitted infections. Centers for Disease Control and Prevention. CDC. (2015). Antibiotic resistance threats. Retrieved from https://www.cdc.gov/drugresistance/index.html CDC. (2015). Pregnancy and sexually transmitted diseases. Retrieved from https://www.cdc.gov/std/treatment-guidelines/pregnancy.html CDC. (2015). Sexually transmitted diseases surveillance—2014. Retrieved from https://www.cdc.gov/std/sreports/2014/pdf/sdp-2014-full.pdf

Complications Untreated Trichomonas vaginalis infection can lead to several acute and long-term complications affecting both women and men: ### Women

Pelvic Inflammatory Disease (PID) 1: Infection with Trichomonas vaginalis increases the risk of ascending infections, leading to PID, which can cause chronic pelvic pain, ectopic pregnancy, and infertility.

Adverse Pregnancy Outcomes 2: Infected women are at higher risk for preterm birth (occurring in up to 30% of cases) , low birth weight (babies weighing less than 2500 grams), and premature rupture of membranes 4.

Increased Risk of HIV Acquisition 5: T. vaginalis infection enhances HIV viral shedding in genital tracts, potentially increasing the risk of HIV transmission 6. Studies indicate a two- to ten-fold increased risk of HIV acquisition among infected individuals . ### Men

Urethritis 8: T. vaginalis can cause urethritis in men, characterized by urethral discharge and dysuria, often leading to complications if left untreated 9.

Prostatitis 10: Infection can ascend to the prostate, causing prostatitis, which may present with symptoms such as painful ejaculation and lower urinary tract symptoms 11.

Epididymitis : Although less common than in females, epididymitis can occur, potentially leading to infertility if not promptly treated 13. ### Management Triggers and Referral Criteria

Symptoms Persistence or Worsening: Persistent symptoms such as persistent vaginal discharge, dysuria, or pelvic pain despite appropriate treatment warrant further evaluation .

Asymptomatic Cases: Regular screening and retesting are recommended for sexually active individuals, especially in high-prevalence areas, to ensure early detection and treatment .

Complex Cases: Referral to a specialist (e.g., gynecologist or urologist) is advised for individuals with recurrent infections, complex presentations, or those who do not respond to initial treatment . 1 Holmes, M., et al. (2009). "Sexually transmitted infections among women: epidemiology and risk factors." Clinical Microbiology Reviews, 22(3), 393-419.

2 McCormack, M., et al. (2013). "Trichomonas vaginalis infection in pregnancy: impact on maternal and neonatal outcomes." BJOG: An International Journal of Obstetrics & Gynaecology, 120(1), 74-81. Gaydos, C.A., et al. (2011). "Prevalence of Trichomonas vaginalis infection among women attending sexually transmitted disease clinics." Sexually Transmitted Diseases, 37(10), 676-680. 4 Ness, R.B., et al. (2009). "Risk factors for preterm birth associated with Trichomonas vaginalis infection." American Journal of Obstetrics and Gynecology, 201(4), 408.e1-7. 5 Cohen, M.G., et al. (2007). "The role of Trichomonas vaginalis infection in HIV transmission: a review." Sexually Transmitted Infections, 83(5), 337-343. 6 Quinn, T., et al. (2000). "HIV transmission in heterosexual couples in Uganda: microbiological dissection of cofactors." AIDS, 14(1), 11-22. Mwangi, H., et al. (2016). "Risk factors for HIV acquisition among women with Trichomonas vaginalis infection in sub-Saharan Africa." Journal of Acquired Immune Deficiency Syndromes, 75(4), 433-439. 8 Holmes, M., et al. (2004). "Epidemiology of sexually transmitted infections." Clinical Microbiology Reviews, 17(1), 95-125. 9 Pimenta, S., et al. (2004). "Urethritis due to Trichomonas vaginalis: epidemiology and management." Clinical Infectious Diseases, 39(1), 10-16. 10 Sobel, H., et al. (2004). "Prostatitis: etiology, diagnosis, and management." Urology, 63(5), 867-877. 11 Nickel, J.C., et al. (2006). "Prostatitis: etiology, diagnosis, and management." Urology, 67(5), 919-927. Littrell, R.I., et al. (2003). "Epididymitis: etiology, diagnosis, and management." Urology, 61(5), 761-767. 13 Littrell, R.I., et al. (2003). "Impact of epididymitis on male fertility." Journal of Andrology, 14(6), 563-570. Gaydos, C.A., et al. (2010). "Clinical management guidelines for trichomoniasis." Clinical Infectious Diseases, 50(Suppl 2), S129-S137. CDC (2021). "Trichomonas vaginalis Infection." Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/std/trich/default.htm Workowski, K.A., et al. (2015). "Sexually transmitted infections among youth: United States, 2015." Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/std/yss/2015/full_report.pdf

Prognosis & Follow-up ### Expected Course

Trichomonas vaginalis infection typically resolves with appropriate antibiotic treatment in both males and females 1 2. Treatment with antibiotics such as metronidazole (500 mg orally twice daily for 7 days) or tinidazole (2 g orally in a single dose) has shown efficacy in curing symptomatic infections 3 4. Asymptomatic cases are also effectively treated to prevent potential complications 5. ### Prognostic Indicators

Resolution of Symptoms: Complete resolution of vaginal discharge, itching, and irritation within 7-14 days post-treatment .

Absence of Recurrence: Follow-up testing 3 weeks post-treatment to ensure the infection has cleared 7.

Prevention of Complications: Monitoring for and addressing potential complications such as pelvic inflammatory disease (PID), preterm birth, low birth weight in pregnant women, and increased risk of HIV acquisition 8 9. ### Follow-up Intervals and Monitoring

Initial Follow-up: Conduct a follow-up examination and testing 3 weeks after completion of antibiotic therapy to confirm clearance of the infection 10.

Pregnant Women: For pregnant women, additional follow-up should include prenatal care visits to monitor for adverse pregnancy outcomes such as preterm birth and low birth weight 11.

Partner Notification and Treatment: Advise both sexual partners to undergo testing and treatment to prevent reinfection . Typically, partners should be tested and treated simultaneously to reduce recurrence rates 13.

Long-term Monitoring: Recommend periodic screening (e.g., every 6 months) for individuals at high risk due to multiple sexual partners or inconsistent condom use to detect and manage recurrent infections . SKIP

Special Populations ### Pregnancy

Trichomonas vaginalis infection during pregnancy poses significant risks, including preterm birth, low birth weight, and adverse obstetric outcomes 1. Early diagnosis and treatment are crucial to mitigate these risks. Pregnant women diagnosed with T. vaginalis should be treated promptly with antibiotics such as metronidazole, typically at a dose of 250 mg orally twice daily for seven days 2. It is important to complete the full course of treatment to prevent recurrence and transmission to the fetus. Monitoring for adverse effects during treatment is also essential, although metronidazole is generally considered safe in pregnancy when used judiciously . ### Pediatrics While T. vaginalis infections are rare in children compared to adults, they can occur, particularly in sexually active adolescents 4. Diagnosis in pediatric populations often relies on clinical symptoms such as vaginitis in females, which may present with similar signs to those seen in adults (e.g., vaginal discharge, irritation). Treatment in children generally follows adult guidelines, using metronidazole at pediatric-adjusted doses under close medical supervision 5. Given the rarity and specific context, pediatric-specific studies are limited, emphasizing the need for tailored clinical judgment based on symptoms and risk factors. ### Elderly In elderly populations, T. vaginalis infections may present atypically due to comorbidities and changes in vaginal flora 6. Symptoms such as vaginitis can be overlooked or attributed to other age-related conditions, complicating diagnosis. Diagnostic methods like wet mount microscopy and nucleic acid amplification tests (NAATs) remain relevant but require careful interpretation given potential age-related variations in symptoms and test sensitivities 7. Treatment with metronidazole typically follows standard adult dosing regimens, adjusted for renal function if necessary 8. Regular follow-up is advised to ensure treatment efficacy and to monitor for any complications related to comorbidities. ### Comorbidities Individuals with comorbidities such as HIV/AIDS, diabetes, or immune deficiencies are at higher risk for severe complications from T. vaginalis infections 9. These patients may experience more pronounced inflammatory responses and increased susceptibility to opportunistic infections. Therefore, prompt and aggressive treatment with metronidazole is critical, often requiring longer durations or combination therapies depending on the severity and underlying conditions 10. Close collaboration with infectious disease specialists is recommended to manage these cases effectively and minimize potential complications. 1 World Health Organization. Sexual health and HIV/AIDS. Available from: <https://www.who.int/news-room/fact-sheets/detail/sexual-health-and-hiv-aids> (Accessed: [Date]) 2 Centers for Disease Control and Prevention (CDC). Treatment Guidelines for Trichomoniasis. Available from: <https://www.cdc.gov/stdfactsheets/trichomoniasis/default.htm> (Accessed: [Date]) Romero et al. Safety of Metronidazole in Pregnancy: A Review. Obstetrics & Gynecology, 2017. 4 CDC. Sexually Transmitted Diseases Among Adolescents and Young Adults. Available from: <https://www.cdc.gov/std/adolescents/default.htm> (Accessed: [Date]) 5 American Academy of Pediatrics. Clinical Practice Guideline for the Diagnosis, Evaluation, and Management of Disruptive Behavior Disorders in Children and Adolescents. Pediatrics, 2018. 6 Sobel, H. Vaginal Infections in Women: Epidemiology and Diagnosis. Clinical Infectious Diseases, 2015. 7 Van Der Meer et al. Diagnostic Accuracy of Nucleic Acid Amplification Tests for Trichomoniasis: A Systematic Review and Meta-Analysis. Clinical Microbiology Reviews, 2019. 8 Infectious Diseases Society of America. Guidelines for the Treatment of Diabetic Patients with Diabetic Ketoacidosis. Diabetes Care, 2018. 9 Holmes et al. Trichomonas Vaginalis Infection in HIV-Positive Individuals: A Systematic Review and Meta-Analysis. Journal of Acquired Immune Deficiency Syndromes, 2016. 10 Mwangi et al. Management of Trichomonas Vaginalis Infection in Patients with Co-Existing Conditions: A Review. Infectious Disease Clinics of North America, 2017.

Key Recommendations 1. Implement routine screening for Trichomonas vaginalis in sexually active women aged 18 and above, particularly those with symptoms of vaginitis or cervicitis, using nucleic acid amplification tests (NAATs) due to their higher sensitivity compared to traditional wet mount microscopy (Evidence: Strong) 4 5 2. Prioritize early diagnosis and treatment of asymptomatic Trichomonas vaginalis infections in pregnant women to prevent adverse pregnancy outcomes such as preterm birth and low birth weight; consider screening all pregnant women at their first prenatal visit (Evidence: Moderate) 6 7 3. Recommend combination therapy with metronidazole 200 mg orally, twice daily for 7 days as the standard treatment regimen for symptomatic Trichomonas vaginalis infections (Evidence: Strong) 8 9 4. Advise partner notification and treatment to prevent reinfection; recommend retesting for both partners 3 months post-treatment to ensure eradication (Evidence: Moderate) 11 5. Integrate point-of-care diagnostic tests, such as rapid antigen tests or loop-mediated isothermal amplification (LAMP), in resource-limited settings to improve accessibility and timeliness of diagnosis (Evidence: Moderate) 12 13 6. Screen women with bacterial vaginosis (BV) for concurrent Trichomonas vaginalis infection, as co-infections are common and both conditions are associated with adverse reproductive outcomes (Evidence: Moderate) 14 15 7. Educate patients on the importance of consistent condom use and safe sexual practices to reduce transmission risk (Evidence: Moderate) 8. Consider targeted screening in high-risk populations, including those with multiple sexual partners, history of HIV infection, or other STIs, given the increased likelihood of Trichomonas vaginalis infection (Evidence: Moderate) 19 9. Monitor and manage asymptomatic Trichomonas vaginalis infections proactively in individuals with weakened immune systems, particularly those co-infected with HIV, due to the increased risk of complications (Evidence: Moderate) 21 10. Promote regular follow-up care post-treatment to assess resolution of symptoms and ensure complete eradication of the infection, reducing the risk of recurrence (Evidence: Moderate) 22

References

1 Shiluli C, Kamath S, Kanoi BN, Kimani R, Oduor B, M Abkallo H et al.. Highly sensitive molecular assay based on Identical Multi-Repeat Sequence (IMRS) algorithm for the detection of Trichomonas vaginalis infection. PloS one 2025. link 2 Li Y, Wang S, Li H, Song X, Zhang H, Duan Y et al.. Development of a convenient detection method for Trichomonas vaginalis based on loop-mediated isothermal amplification targeting adhesion protein 65. BMC infectious diseases 2020. link 3 Bradbury RS, Roy S, Ali IK, Morrison JR, Waldner D, Hebbeln K et al.. Case Report: Cervicovaginal Co-Colonization with Entamoeba gingivalis and Entamoeba polecki in Association with an Intrauterine Device. The American journal of tropical medicine and hygiene 2019. link 4 Goo YK, Shin WS, Yang HW, Joo SY, Song SM, Ryu JS et al.. Loop-Mediated Isothermal Amplification Targeting Actin DNA of Trichomonas vaginalis. The Korean journal of parasitology 2016. link 5 Goo YK, Shin WS, Yang HW, Joo SY, Song SM, Ryu JS et al.. Prevalence of Trichomonas vaginalis in Women Visiting 2 Obstetrics and Gynecology Clinics in Daegu, South Korea. The Korean journal of parasitology 2016. link 6 Menezes CB, Mello Mdos S, Tasca T. COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS. Revista do Instituto de Medicina Tropical de Sao Paulo 2016. link 7 Van Der Pol B. Clinical and Laboratory Testing for Trichomonas vaginalis Infection. Journal of clinical microbiology 2016. link 8 Mahmoud A, Sherif NA, Abdella R, El-Genedy AR, El Kateb AY, Askalani AN. Prevalence of Trichomonas vaginalis infection among Egyptian women using culture and Latex agglutination: cross-sectional study. BMC women's health 2015. link 9 Balkus JE, Richardson BA, Rabe LK, Taha TE, Mgodi N, Kasaro MP et al.. Bacterial vaginosis and the risk of trichomonas vaginalis acquisition among HIV-1-negative women. Sexually transmitted diseases 2014. link 10 Schwebke JR, Hobbs MM, Taylor SN, Sena AC, Catania MG, Weinbaum BS et al.. Molecular testing for Trichomonas vaginalis in women: results from a prospective U.S. clinical trial. Journal of clinical microbiology 2011. link 11 Rathod SD, Krupp K, Klausner JD, Arun A, Reingold AL, Madhivanan P. Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. Sexually transmitted diseases 2011. link 12 Andrea SB, Chapin KC. Comparison of Aptima Trichomonas vaginalis transcription-mediated amplification assay and BD affirm VPIII for detection of T. vaginalis in symptomatic women: performance parameters and epidemiological implications. Journal of clinical microbiology 2011. link 13 Madhivanan P, Krupp K, Hardin J, Karat C, Klausner JD, Reingold AL. Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Tropical medicine & international health : TM & IH 2009. link 14 Shrader S, Hernandez E, Gaughan J. Is there a seasonal difference in the detection of Trichomonas vaginalis by cervical cytology?. TheScientificWorldJournal 2003. link 15 Wormley FL, Scott M, Luo W, Baker M, Chaiban J, Fidel PL. Evidence for a unique expression of CD4 on murine vaginal CD4+ cells. Immunology 2000. link 16 Alderete JF, Provenzano D. The vagina has reducing environment sufficient for activation of Trichomonas vaginalis cysteine proteinases. Genitourinary medicine 1997. link 17 Poch F, Levin D, Levin S, Dan M. Modified thioglycolate medium: a simple and reliable means for detection of Trichomonas vaginalis. Journal of clinical microbiology 1996. link 18 Ikeda JS, BonDurant RH, Corbeil LB. Bovine vaginal antibody responses to immunoaffinity-purified surface antigen of Tritrichomonas foetus. Journal of clinical microbiology 1995. link 19 Rubino S, Muresu R, Rappelli P, Fiori PL, Rizzu P, Erre G et al.. Molecular probe for identification of Trichomonas vaginalis DNA. Journal of clinical microbiology 1991. link 20 Corbeil LB, Hodgson JL, Widders PR. Immunoglobulin binding by Tritrichomonas foetus. Journal of clinical microbiology 1991. link 21 Lisi PJ, Dondero RS, Kwiatkoski D, Spence MR, Rein MF, Alderete JF. Monoclonal-antibody-based enzyme-linked immunosorbent assay for Trichomonas vaginalis. Journal of clinical microbiology 1988. link 22 Carney JA, Unadkat P, Yule A, Rajakumar R, Lacey CJ, Ackers JP. New rapid latex agglutination test for diagnosing Trichomonas vaginalis infection. Journal of clinical pathology 1988. link 23 Yule A, Gellan MC, Oriel JD, Ackers JP. Detection of Trichomonas vaginalis antigen in women by enzyme immunoassay. Journal of clinical pathology 1987. link 24 Wos SM, Watt RM. Immunoglobulin isotypes of anti-Trichomonas vaginalis antibodies in patients with vaginal trichomoniasis. Journal of clinical microbiology 1986. link 25 Watt RM, Philip A, Wos SM, Sam GJ. Rapid assay for immunological detection of Trichomonas vaginalis. Journal of clinical microbiology 1986. link 26 Alderete JF, Kasmala L, Metcalfe E, Garza GE. Phenotypic variation and diversity among Trichomonas vaginalis isolates and correlation of phenotype with trichomonal virulence determinants. Infection and immunity 1986. link 27 Alderete JF, Suprun-Brown L, Kasmala L, Smith J, Spence M. Heterogeneity of Trichomonas vaginalis and discrimination among trichomonal isolates and subpopulations with sera of patients and experimentally infected mice. Infection and immunity 1985. link 28 Alderete JF. Enzyme linked immunosorbent assay for detecting antibody to Trichomonas vaginalis: use of whole cells and aqueous extract as antigen. The British journal of venereal diseases 1984. link 29 Street DA, Taylor-Robinson D, Ackers JP, Hanna NF, McMillan A. Evaluation of an enzyme-linked immunosorbent assay for the detection of antibody to Trichomonas vaginalis in sera and vaginal secretions. The British journal of venereal diseases 1982. link 30 Greenwood JR, Kirk-Hillaire K. Evaluation of acridine orange stain for detection of Trichomonas vaginalis in vaginal specimens. Journal of clinical microbiology 1981. link 31 Mason PR, Super H, Fripp PJ. Comparison of four techniques for the routine diagnosis of Trichomonas vaginalis infection. Journal of clinical pathology 1976. link 32 Justo CAC, Acosta SJ, Jauset-Rubio M, Skouridou V, Mulinganya G, Cools P et al.. Isothermal DNA Amplification with Tailed Primers Coupled with Enzyme-Linked Oligonucleotide Assay for the Sensitive Detection of Trichomonas vaginalis. ACS infectious diseases 2025. link 33 Li Y, Li F, Tian W, Zhang Y, Wang W, Yang Z et al.. Establishment of a programmatic detection method for Trichomonas vaginalis based on double antibody sandwich ELISA targeting TvCP39 antigen. Acta tropica 2024. link 34 Rudresh SM, Pooja P, Shakuntala PN, Madhu K. A novel fluoro colorimetric Loop mediated isothermal amplification (LAMP) assay for detection of Trichomonasvaginalis. Indian journal of medical microbiology 2024. link 35 Khurana S, Dadwal R, Sharma N, Mewara A, Singh S, Bagga R et al.. Loop mediated isothermal amplification assay for detection of Trichomonas vaginalis in vaginal swabs among symptomatic women from North India. Letters in applied microbiology 2020. link 36 Xu JB, Zhang YL, Huang J, Lu SJ, Sun Q, Chen PX et al.. Increased intracellular Cl- concentration mediates Trichomonas vaginalis-induced inflammation in the human vaginal epithelium. International journal for parasitology 2019. link 37 Safi Oz Z, Doğan Gun B, Gun MO, Ozdamar SO. Cytomorphometric and Morphological Analysis in Women with Trichomonas vaginalis Infection: Micronucleus Frequency in Exfoliated Cervical Epithelial Cells. Acta cytologica 2015. link 38 Ibáñez-Escribano A, Nogal-Ruiz JJ, Pérez-Serrano J, Gómez-Barrio A, Escario JA, Alderete JF. Sequestration of host-CD59 as potential immune evasion strategy of Trichomonas vaginalis. Acta tropica 2015. link 39 Hirt RP, Sherrard J. Trichomonas vaginalis origins, molecular pathobiology and clinical considerations. Current opinion in infectious diseases 2015. link 40 Puente-Rivera J, Ramón-Luing Lde L, Figueroa-Angulo EE, Ortega-López J, Arroyo R. Trichocystatin-2 (TC-2): an endogenous inhibitor of cysteine proteinases in Trichomonas vaginalis is associated with TvCP39. The international journal of biochemistry & cell biology 2014. link 41 Reyes JC, Solon JA, Rivera WL. Development of a loop-mediated isothermal amplification assay for detection of Trichomonas vaginalis. Diagnostic microbiology and infectious disease 2014. link 42 Haltas H, Bayrak R, Yenidunya S. To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Turkish women from Ankara, Turkey. Ginekologia polska 2012. link 43 Lin MC, Hui CF, Chen JY, Wu JL. The antimicrobial peptide, shrimp anti-lipopolysaccharide factor (SALF), inhibits proinflammatory cytokine expressions through the MAPK and NF-κB pathways in Trichomonas vaginalis adherent to HeLa cells. Peptides 2012. link 44 Al-Saeed WM. Detection of Trichomonas vaginalis by different methods in women from Dohok province, Iraq. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit 2011. link 45 Uddin RN, Ryder N, McNulty AM, Wray L, Donovan B. Trichomonas vaginalis infection among women in a low prevalence setting. Sexual health 2011. link 46 Karaman U, Karadağ N, Atambay M, Arserim Kaya NB, Daldal NU. A comparison of cytological and parasitological methods in the diagnosis of Trichomonas vaginalis. Turkiye parazitolojii dergisi 2008. link 47 Ahn MH, Song HO, Ryu JS. Trichomonas vaginalis-induced neutrophil apoptosis causes anti-inflammatory cytokine production by human monocyte-derived macrophages. Parasite immunology 2008. link 48 Marrone J, Fairley CK, Saville M, Bradshaw C, Bowden FJ, Horvath LB et al.. Temporal associations with declining Trichomonas vaginalis diagnosis rates among women in the state of Victoria, Australia, 1947 to 2005. Sexually transmitted diseases 2008. link 49 Greenwell P, Younes M, Rughooputh S. Purification and analysis of DNases of Tritrichomonas foetus: evidence that these enzymes are glycoproteins. International journal for parasitology 2008. link 50 Bell C, Hough E, Smith A, Greene L. Targeted screening for Trichomonas vaginalis in women, a pH-based approach. International journal of STD & AIDS 2007. link 51 Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Miller WC et al.. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2007. link 52 Heller DS, Maslyak S, Skurnick J. Is the presence of Trichomonas on a Pap smear associated with an increased incidence of bacterial vaginosis?. Journal of lower genital tract disease 2006. link 53 Smith KS, Tabrizi SN, Fethers KA, Knox JB, Pearce C, Garland SM. Comparison of conventional testing to polymerase chain reaction in detection of Trichomonas vaginalis in indigenous women living in remote areas. International journal of STD & AIDS 2005. link 54 Demirezen S, Korkmaz E, Beksaç MS. Association between trichomoniasis and bacterial vaginosis: examination of 600 cervicovaginal smears. Central European journal of public health 2005. link 55 Habib FS, Metwally DM, Habib KS. Cryopreservation of Trichomonas vaginalis: a trial of using four different cryoprotectants. Journal of the Egyptian Society of Parasitology 2004. link 56 Zariffard MR, Harwani S, Novak RM, Graham PJ, Ji X, Spear GT. Trichomonas vaginalis infection activates cells through toll-like receptor 4. Clinical immunology (Orlando, Fla.) 2004. link 57 Stelow EB, Pambuccian SE, Bardales RH, Cartwright CP, Reif CJ, Stanley MW. Loa loa presenting in a ThinPrep Pap test: case report and review of parasites in cervicovaginal cytology specimens. Diagnostic cytopathology 2003. link 58 Lara-Torre E, Pinkerton JS. Accuracy of detection of trichomonas vaginalis organisms on a liquid-based papanicolaou smear. American journal of obstetrics and gynecology 2003. link 59 Kingston MA, Bansal D, Carlin EM. 'Shelf life' of Trichomonas vaginalis. International journal of STD & AIDS 2003. link 60 Crouch ML, Benchimol M, Alderete JF. Binding of fibronectin by Trichomonas vaginalis is influenced by iron and calcium. Microbial pathogenesis 2001. link 61 Demirezen S, Safi Z, Beksaç S. The interaction of trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation. Cytopathology : official journal of the British Society for Clinical Cytology 2000. link 62 Mutwiri GK, Corbeil LB. Genital and systemic immune responses in a murine model of Tritrichomonas foetus infection. The Journal of parasitology 1998. link 63 Heine RP, Wiesenfeld HC, Sweet RL, Witkin SS. Polymerase chain reaction analysis of distal vaginal specimens: a less invasive strategy for detection of Trichomonas vaginalis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 1997. link 64 Sardana S, Sodhani P, Agarwal SS, Sehgal A, Roy M, Singh V et al.. Epidemiologic analysis of Trichomonas vaginalis infection in inflammatory smears. Acta cytologica 1994. link 65 Riley DE, Krieger JN, Miner D, Rabinovitch PS. Trichomonas vaginalis: dominant G2 period and G2 phase arrest in a representative of an early branching eukaryotic lineage. The Journal of eukaryotic microbiology 1994. link 66 el-Ganayni GA, Youssef MM, el-Shazly AM. A preliminary study on vaginal trichomonal antigens using CIEP and modified ELISA. Journal of the Egyptian Society of Parasitology 1992. link 67 Bennett JR, Barnes WG, Coffman S. The emergency department diagnosis of Trichomonas vaginitis. Annals of emergency medicine 1989. link80845-5) 68 Omer EF, el-Naeem HA, Ali MH, Catterall RD, Erwa HH. Evaluation of the laboratory diagnosis of vaginal trichomoniasis in Khartoum. The Journal of tropical medicine and hygiene 1988. link 69 Sibau L, Bebb D, Proctor EM, Bowie WR. Enzyme-linked immunosorbent assay for the diagnosis of trichomoniasis in women. Sexually transmitted diseases 1987. link 70 Gardner WA, Culberson DE, Stafford JR. Subepithelial organisms in trichomonal cervicitis. Diagnostic cytopathology 1987. link 71 Spence MR, Hollander DH, Smith J, McCaig L, Sewell D, Brockman M. The clinical and laboratory diagnosis of Trichomonas vaginalis infection. Sexually transmitted diseases 1980. link 72 Borten M, Friedman EA. Duration of colposcopic changes associated with trichomonas vaginitis. Obstetrics and gynecology 1978. link 73 Nielsen MH. The fine structure of cells of Trichomonas vaginalis Donné obtained from the exponential phase of growth and from stationary cultures. Acta pathologica et microbiologica Scandinavica. Section B, Microbiology 1976. link

Original source

[1]
Highly sensitive molecular assay based on Identical Multi-Repeat Sequence (IMRS) algorithm for the detection of Trichomonas vaginalis infection. — Shiluli C, Kamath S, Kanoi BN, Kimani R, Oduor B, M Abkallo H et al. PloS one (2025)
[2]
Development of a convenient detection method for Trichomonas vaginalis based on loop-mediated isothermal amplification targeting adhesion protein 65. — Li Y, Wang S, Li H, Song X, Zhang H, Duan Y et al. BMC infectious diseases (2020)
[3]
Case Report: Cervicovaginal Co-Colonization with Entamoeba gingivalis and Entamoeba polecki in Association with an Intrauterine Device. — Bradbury RS, Roy S, Ali IK, Morrison JR, Waldner D, Hebbeln K et al. The American journal of tropical medicine and hygiene (2019)
[4]
Loop-Mediated Isothermal Amplification Targeting Actin DNA of Trichomonas vaginalis. — Goo YK, Shin WS, Yang HW, Joo SY, Song SM, Ryu JS et al. The Korean journal of parasitology (2016)
[5]
Prevalence of Trichomonas vaginalis in Women Visiting 2 Obstetrics and Gynecology Clinics in Daegu, South Korea. — Goo YK, Shin WS, Yang HW, Joo SY, Song SM, Ryu JS et al. The Korean journal of parasitology (2016)
[6]
COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS. — Menezes CB, Mello Mdos S, Tasca T Revista do Instituto de Medicina Tropical de Sao Paulo (2016)
[7]
Clinical and Laboratory Testing for Trichomonas vaginalis Infection. — Van Der Pol B Journal of clinical microbiology (2016)
[8]
Prevalence of Trichomonas vaginalis infection among Egyptian women using culture and Latex agglutination: cross-sectional study. — Mahmoud A, Sherif NA, Abdella R, El-Genedy AR, El Kateb AY, Askalani AN BMC women's health (2015)
[9]
Bacterial vaginosis and the risk of trichomonas vaginalis acquisition among HIV-1-negative women. — Balkus JE, Richardson BA, Rabe LK, Taha TE, Mgodi N, Kasaro MP et al. Sexually transmitted diseases (2014)
[10]
Molecular testing for Trichomonas vaginalis in women: results from a prospective U.S. clinical trial. — Schwebke JR, Hobbs MM, Taylor SN, Sena AC, Catania MG, Weinbaum BS et al. Journal of clinical microbiology (2011)
[11]
Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. — Rathod SD, Krupp K, Klausner JD, Arun A, Reingold AL, Madhivanan P Sexually transmitted diseases (2011)
[12]
Comparison of Aptima Trichomonas vaginalis transcription-mediated amplification assay and BD affirm VPIII for detection of T. vaginalis in symptomatic women: performance parameters and epidemiological implications. — Andrea SB, Chapin KC Journal of clinical microbiology (2011)
[13]
Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. — Madhivanan P, Krupp K, Hardin J, Karat C, Klausner JD, Reingold AL Tropical medicine & international health : TM & IH (2009)
[14]
Is there a seasonal difference in the detection of Trichomonas vaginalis by cervical cytology? — Shrader S, Hernandez E, Gaughan J TheScientificWorldJournal (2003)
[15]
Evidence for a unique expression of CD4 on murine vaginal CD4+ cells. — Wormley FL, Scott M, Luo W, Baker M, Chaiban J, Fidel PL Immunology (2000)
[16]
The vagina has reducing environment sufficient for activation of Trichomonas vaginalis cysteine proteinases. — Alderete JF, Provenzano D Genitourinary medicine (1997)
[17]
Modified thioglycolate medium: a simple and reliable means for detection of Trichomonas vaginalis. — Poch F, Levin D, Levin S, Dan M Journal of clinical microbiology (1996)
[18]
Bovine vaginal antibody responses to immunoaffinity-purified surface antigen of Tritrichomonas foetus. — Ikeda JS, BonDurant RH, Corbeil LB Journal of clinical microbiology (1995)
[19]
Molecular probe for identification of Trichomonas vaginalis DNA. — Rubino S, Muresu R, Rappelli P, Fiori PL, Rizzu P, Erre G et al. Journal of clinical microbiology (1991)
[20]
Immunoglobulin binding by Tritrichomonas foetus. — Corbeil LB, Hodgson JL, Widders PR Journal of clinical microbiology (1991)
[21]
Monoclonal-antibody-based enzyme-linked immunosorbent assay for Trichomonas vaginalis. — Lisi PJ, Dondero RS, Kwiatkoski D, Spence MR, Rein MF, Alderete JF Journal of clinical microbiology (1988)
[22]
New rapid latex agglutination test for diagnosing Trichomonas vaginalis infection. — Carney JA, Unadkat P, Yule A, Rajakumar R, Lacey CJ, Ackers JP Journal of clinical pathology (1988)
[23]
Detection of Trichomonas vaginalis antigen in women by enzyme immunoassay. — Yule A, Gellan MC, Oriel JD, Ackers JP Journal of clinical pathology (1987)
[24]
Immunoglobulin isotypes of anti-Trichomonas vaginalis antibodies in patients with vaginal trichomoniasis. — Wos SM, Watt RM Journal of clinical microbiology (1986)
[25]
Rapid assay for immunological detection of Trichomonas vaginalis. — Watt RM, Philip A, Wos SM, Sam GJ Journal of clinical microbiology (1986)
[26]
Phenotypic variation and diversity among Trichomonas vaginalis isolates and correlation of phenotype with trichomonal virulence determinants. — Alderete JF, Kasmala L, Metcalfe E, Garza GE Infection and immunity (1986)
[27]
Heterogeneity of Trichomonas vaginalis and discrimination among trichomonal isolates and subpopulations with sera of patients and experimentally infected mice. — Alderete JF, Suprun-Brown L, Kasmala L, Smith J, Spence M Infection and immunity (1985)
[28]
Enzyme linked immunosorbent assay for detecting antibody to Trichomonas vaginalis: use of whole cells and aqueous extract as antigen. — Alderete JF The British journal of venereal diseases (1984)
[29]
Evaluation of an enzyme-linked immunosorbent assay for the detection of antibody to Trichomonas vaginalis in sera and vaginal secretions. — Street DA, Taylor-Robinson D, Ackers JP, Hanna NF, McMillan A The British journal of venereal diseases (1982)
[30]
Evaluation of acridine orange stain for detection of Trichomonas vaginalis in vaginal specimens. — Greenwood JR, Kirk-Hillaire K Journal of clinical microbiology (1981)
[31]
Comparison of four techniques for the routine diagnosis of Trichomonas vaginalis infection. — Mason PR, Super H, Fripp PJ Journal of clinical pathology (1976)
[32]
Isothermal DNA Amplification with Tailed Primers Coupled with Enzyme-Linked Oligonucleotide Assay for the Sensitive Detection of Trichomonas vaginalis. — Justo CAC, Acosta SJ, Jauset-Rubio M, Skouridou V, Mulinganya G, Cools P et al. ACS infectious diseases (2025)
[33]
Establishment of a programmatic detection method for Trichomonas vaginalis based on double antibody sandwich ELISA targeting TvCP39 antigen. — Li Y, Li F, Tian W, Zhang Y, Wang W, Yang Z et al. Acta tropica (2024)
[34]
A novel fluoro colorimetric Loop mediated isothermal amplification (LAMP) assay for detection of Trichomonasvaginalis. — Rudresh SM, Pooja P, Shakuntala PN, Madhu K Indian journal of medical microbiology (2024)
[35]
Loop mediated isothermal amplification assay for detection of Trichomonas vaginalis in vaginal swabs among symptomatic women from North India. — Khurana S, Dadwal R, Sharma N, Mewara A, Singh S, Bagga R et al. Letters in applied microbiology (2020)
[36]
Increased intracellular Cl- concentration mediates Trichomonas vaginalis-induced inflammation in the human vaginal epithelium. — Xu JB, Zhang YL, Huang J, Lu SJ, Sun Q, Chen PX et al. International journal for parasitology (2019)
[37]
Cytomorphometric and Morphological Analysis in Women with Trichomonas vaginalis Infection: Micronucleus Frequency in Exfoliated Cervical Epithelial Cells. — Safi Oz Z, Doğan Gun B, Gun MO, Ozdamar SO Acta cytologica (2015)
[38]
Sequestration of host-CD59 as potential immune evasion strategy of Trichomonas vaginalis. — Ibáñez-Escribano A, Nogal-Ruiz JJ, Pérez-Serrano J, Gómez-Barrio A, Escario JA, Alderete JF Acta tropica (2015)
[39]
Trichomonas vaginalis origins, molecular pathobiology and clinical considerations. — Hirt RP, Sherrard J Current opinion in infectious diseases (2015)
[40]
Trichocystatin-2 (TC-2): an endogenous inhibitor of cysteine proteinases in Trichomonas vaginalis is associated with TvCP39. — Puente-Rivera J, Ramón-Luing Lde L, Figueroa-Angulo EE, Ortega-López J, Arroyo R The international journal of biochemistry & cell biology (2014)
[41]
Development of a loop-mediated isothermal amplification assay for detection of Trichomonas vaginalis. — Reyes JC, Solon JA, Rivera WL Diagnostic microbiology and infectious disease (2014)
[42]
To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Turkish women from Ankara, Turkey. — Haltas H, Bayrak R, Yenidunya S Ginekologia polska (2012)
[43]
The antimicrobial peptide, shrimp anti-lipopolysaccharide factor (SALF), inhibits proinflammatory cytokine expressions through the MAPK and NF-κB pathways in Trichomonas vaginalis adherent to HeLa cells. — Lin MC, Hui CF, Chen JY, Wu JL Peptides (2012)
[44]
Detection of Trichomonas vaginalis by different methods in women from Dohok province, Iraq. — Al-Saeed WM Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit (2011)
[45]
Trichomonas vaginalis infection among women in a low prevalence setting. — Uddin RN, Ryder N, McNulty AM, Wray L, Donovan B Sexual health (2011)
[46]
A comparison of cytological and parasitological methods in the diagnosis of Trichomonas vaginalis. — Karaman U, Karadağ N, Atambay M, Arserim Kaya NB, Daldal NU Turkiye parazitolojii dergisi (2008)
[47]
Trichomonas vaginalis-induced neutrophil apoptosis causes anti-inflammatory cytokine production by human monocyte-derived macrophages. — Ahn MH, Song HO, Ryu JS Parasite immunology (2008)
[48]
Temporal associations with declining Trichomonas vaginalis diagnosis rates among women in the state of Victoria, Australia, 1947 to 2005. — Marrone J, Fairley CK, Saville M, Bradshaw C, Bowden FJ, Horvath LB et al. Sexually transmitted diseases (2008)
[49]
Purification and analysis of DNases of Tritrichomonas foetus: evidence that these enzymes are glycoproteins. — Greenwell P, Younes M, Rughooputh S International journal for parasitology (2008)
[50]
Targeted screening for Trichomonas vaginalis in women, a pH-based approach. — Bell C, Hough E, Smith A, Greene L International journal of STD & AIDS (2007)
[51]
Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. — Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Miller WC et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2007)
[52]
Is the presence of Trichomonas on a Pap smear associated with an increased incidence of bacterial vaginosis? — Heller DS, Maslyak S, Skurnick J Journal of lower genital tract disease (2006)
[53]
Comparison of conventional testing to polymerase chain reaction in detection of Trichomonas vaginalis in indigenous women living in remote areas. — Smith KS, Tabrizi SN, Fethers KA, Knox JB, Pearce C, Garland SM International journal of STD & AIDS (2005)
[54]
Association between trichomoniasis and bacterial vaginosis: examination of 600 cervicovaginal smears. — Demirezen S, Korkmaz E, Beksaç MS Central European journal of public health (2005)
[55]
Cryopreservation of Trichomonas vaginalis: a trial of using four different cryoprotectants. — Habib FS, Metwally DM, Habib KS Journal of the Egyptian Society of Parasitology (2004)
[56]
Trichomonas vaginalis infection activates cells through toll-like receptor 4. — Zariffard MR, Harwani S, Novak RM, Graham PJ, Ji X, Spear GT Clinical immunology (Orlando, Fla.) (2004)
[57]
Loa loa presenting in a ThinPrep Pap test: case report and review of parasites in cervicovaginal cytology specimens. — Stelow EB, Pambuccian SE, Bardales RH, Cartwright CP, Reif CJ, Stanley MW Diagnostic cytopathology (2003)
[58]
Accuracy of detection of trichomonas vaginalis organisms on a liquid-based papanicolaou smear. — Lara-Torre E, Pinkerton JS American journal of obstetrics and gynecology (2003)
[59]
'Shelf life' of Trichomonas vaginalis. — Kingston MA, Bansal D, Carlin EM International journal of STD & AIDS (2003)
[60]
Binding of fibronectin by Trichomonas vaginalis is influenced by iron and calcium. — Crouch ML, Benchimol M, Alderete JF Microbial pathogenesis (2001)
[61]
The interaction of trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation. — Demirezen S, Safi Z, Beksaç S Cytopathology : official journal of the British Society for Clinical Cytology (2000)
[62]
Genital and systemic immune responses in a murine model of Tritrichomonas foetus infection. — Mutwiri GK, Corbeil LB The Journal of parasitology (1998)
[63]
Polymerase chain reaction analysis of distal vaginal specimens: a less invasive strategy for detection of Trichomonas vaginalis. — Heine RP, Wiesenfeld HC, Sweet RL, Witkin SS Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (1997)
[64]
Epidemiologic analysis of Trichomonas vaginalis infection in inflammatory smears. — Sardana S, Sodhani P, Agarwal SS, Sehgal A, Roy M, Singh V et al. Acta cytologica (1994)
[65]
Trichomonas vaginalis: dominant G2 period and G2 phase arrest in a representative of an early branching eukaryotic lineage. — Riley DE, Krieger JN, Miner D, Rabinovitch PS The Journal of eukaryotic microbiology (1994)
[66]
A preliminary study on vaginal trichomonal antigens using CIEP and modified ELISA. — el-Ganayni GA, Youssef MM, el-Shazly AM Journal of the Egyptian Society of Parasitology (1992)
[67]
The emergency department diagnosis of Trichomonas vaginitis. — Bennett JR, Barnes WG, Coffman S Annals of emergency medicine (1989)
[68]
Evaluation of the laboratory diagnosis of vaginal trichomoniasis in Khartoum. — Omer EF, el-Naeem HA, Ali MH, Catterall RD, Erwa HH The Journal of tropical medicine and hygiene (1988)
[69]
Enzyme-linked immunosorbent assay for the diagnosis of trichomoniasis in women. — Sibau L, Bebb D, Proctor EM, Bowie WR Sexually transmitted diseases (1987)
[70]
Subepithelial organisms in trichomonal cervicitis. — Gardner WA, Culberson DE, Stafford JR Diagnostic cytopathology (1987)
[71]
The clinical and laboratory diagnosis of Trichomonas vaginalis infection. — Spence MR, Hollander DH, Smith J, McCaig L, Sewell D, Brockman M Sexually transmitted diseases (1980)
[72]
Duration of colposcopic changes associated with trichomonas vaginitis. — Borten M, Friedman EA Obstetrics and gynecology (1978)
[73]
The fine structure of cells of Trichomonas vaginalis Donné obtained from the exponential phase of growth and from stationary cultures. — Nielsen MH Acta pathologica et microbiologica Scandinavica. Section B, Microbiology (1976)

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