Trichomonas Vaginalis

You are an FY2 in GP practice
Anthony Joshua, 35 yr old gentleman has presented with some concerns
Talk to him and address his concerns

Grips
Paraphrase

P1…Worried since partner was diagnosed with an STI…trichomonas vaginalis

Which of the STI…trich. vaginalis
How is ur health ?
Sx of partner
Discharge PV,itching,

Sexual hx(signpost)…no safe sex
PMAFTOSA+DESA
ICE
Examine…vitals, gpe,front passage

Management
Well Anthony we are concerned that you are at risk of having this TV since you mentioned u have had unprotected intercourse with ur partner and the condition is sexually transmitted.

Prescribe Antibiotics…metronidazole

Send him to Sexual health clinic to screen for STI…patient might refuse

Inform senior
Leaflet on TV
Safetynet

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Overview
-Trichomoniasis
Contents
Overview
Diagnosis
Treatment
Prevention
Trichomoniasis is a sexually transmitted infection (STI) caused by a parasite called Trichomonas vaginalis (TV).

Symptoms of trichomoniasis
Symptoms of trichomoniasis usually develop within a month of infection.

But up to half of all people will not develop any symptoms (though they can still pass the infection on to others).

The symptoms of trichomoniasis are similar to those of many other sexually transmitted infections (STIs), so it can sometimes be difficult to diagnose.

Symptoms in women
Trichomoniasis in women can cause:

abnormal vaginal discharge that may be thick, thin or frothy and yellow-green in colour
producing more discharge than normal, which may also have an unpleasant fishy smell
soreness, swelling and itching around the vagina – sometimes the inner thighs also become itchy
pain or discomfort when passing urine or having sex
Symptoms in men
Trichomoniasis in men can cause:

pain when peeing or during ejaculation
needing to pee more frequently than usual
thin, white discharge from the penis
soreness, swelling and redness around the head of the penis or foreskin
When to get medical advice
See a GP or go to your local sexual health clinic (sometimes called a GUM clinic) if you develop any of the symptoms of trichomoniasis or you think you may be infected.

Trichomoniasis can usually be diagnosed after an examination of the genitals and a laboratory test carried out on a swab taken from the vagina or penis.

If the test shows you have trichomoniasis, it’s important that your current sexual partner and any other recent partners are also tested and treated.

How do you get trichomoniasis?
Trichomoniasis is caused by a parasite called Trichomonas vaginalis.

In women, this parasite mainly infects the vagina and the urethra (the tube that carries urine out of the body).

In men, the infection most commonly affects the urethra, but the head of the penis or prostate gland – a gland near the bladder that helps produce semen – can become infected in some cases.

The parasite is usually spread by having sex without using a condom.

It could also be spread by sharing sex toys if you do not wash them or cover them with a new condom before use.

You do not have to have many sexual partners to catch trichomoniasis. Anyone who’s sexually active can catch it and pass it on.

Trichomoniasis is not thought to be passed on through oral or anal sex.

You also cannot pass on trichomoniasis through:

kissing or hugging
sharing cups, plates or cutlery
toilet seats
The best way to prevent trichomoniasis is to have safe sex. This means always using a condom when having sex, covering any sex toys you use with a condom, and washing sex toys after use.

Treating trichomoniasis
Trichomoniasis is unlikely to go away without treatment, but it can be effectively treated with antibiotics.

Most men and women are treated with an antibiotic called metronidazole, which is usually taken twice a day for 5 to 7 days.

It’s important to complete the whole course of antibiotics and avoid having sex until the infection clears up to prevent reinfection.

Your current sexual partner and any other recent partners should also be treated.

Complications of trichomoniasis
Complications of trichomoniasis are rare, although some women with the infection may be at an increased risk of further problems.

If you’re infected with trichomoniasis while you’re pregnant, the infection may cause your baby to be born prematurely or have a low birthweight.
Trichomoniasis can sometimes be difficult to diagnose because symptoms are similar to those of other sexually transmitted infections (STIs).

If you think you may have trichomoniasis, you should visit a GP or your local sexual health clinic (genitourinary medicine (GUM)) clinic.

Some GP surgeries offer an enhanced sexual health service for diagnosing and treating STIs. It may be better to visit a GUM clinic because these clinics can carry out accurate tests more quickly.

In some cases, the GP may refer you to a GUM clinic for tests and treatment if they think you have trichomoniasis.

Important:Using sexual health clinics during coronavirus (COVID-19)
Call a sexual health clinic if you need help or advice. Only go to a clinic if you’ve been told to.

Find sexual health clinic contact details

Examination
If your doctor or nurse suspects you have trichomoniasis, they’ll usually carry out an examination of your genital area.

In women, trichomoniasis may cause abnormal vaginal discharge or red blotches on the walls of the vagina and on the cervix (the neck of the womb).

If you are a man with suspected trichomoniasis, your doctor or nurse will examine your penis for signs of inflammation or discharge.

Laboratory testing
After a physical examination, your doctor or nurse may need to take a swab from either the vagina or penis. The swab will be analysed in a laboratory to check for signs of the trichomoniasis infection. It may take several days for the results to come back.

In men, a urine sample can also be tested for trichomoniasis.

If trichomoniasis is suspected, you may be advised to begin a course of treatment before your results come back. This ensures the infection is treated as soon as possible and reduces the risk of it spreading.

See treating trichomoniasis for more information.

Notifying sexual partners
If the test shows you have trichomoniasis, it’s very important that your current sexual partner and any other recent partners are also tested and treated. The staff at the clinic or GP surgery can discuss with you which of your sexual partners may need to be tested.

If possible, tell your sexual partner and any ex-partners so they can get tested and treated as well. If you do not want to do this, the clinic can usually do it for you (it’s called partner notification and the clinic will not reveal who you are).

If you’ve had trichomoniasis and have been cured, there’s no need to tell any future partners.

Trichomoniasis is unlikely to go away without treatment. The infection may cure itself in rare cases, but you risk passing the infection on to someone else if you are not treated.

Antibiotics
Trichomoniasis is usually treated quickly and easily with antibiotics.

Most people are prescribed an antibiotic called metronidazole, which is very effective if taken correctly. You’ll usually have to take metronidazole twice a day, for 5 to 7 days.

Sometimes this antibiotic can be prescribed in a single, larger dose. However, this may have a higher risk of side effects and it’s not recommended for pregnant or breastfeeding women as a precaution.

Metronidazole can make you feel sick, be sick and cause a slight metallic taste in your mouth. It’s best to take it after eating food. Contact your doctor for advice if you start vomiting, because the treatment will not be effective if you’re unable to swallow the tablets.

Do not drink alcohol while taking metronidazole and for at least 24 hours after finishing the course of antibiotics. Drinking alcohol while taking this medicine can cause more severe side effects, including:

a fast heartbeat or heart palpitations
skin flushing
nausea and vomiting
A specialist can recommend alternative treatments if metronidazole is unsuitable for you (for example, if you’re allergic to it).

Follow-up
If you take your antibiotics correctly, you will not normally need any follow-up tests or examinations for trichomoniasis.

However, you may require further testing to see whether your symptoms are being caused by a different sexually transmitted infection (STI) if your symptoms remain or reoccur after treatment.

If you have unprotected sex before your treatment is finished, you need to return to your GP surgery or sexual health clinic. You may have become reinfected. You must also return if you:

did not complete your course of antibiotics
did not take your antibiotics correctly (according to the instructions)
vomited shortly after taking your antibiotics
You may need more antibiotics or a different form of treatment.

Sexual partners
You should avoid having sex while you’re being treated for trichomoniasis, as you may become reinfected.

If you were prescribed a single dose of antibiotics, you need to avoid having sex for 7 days after taking the medicine.

It’s very important that your current sexual partner and any other recent partners are also tested and treated. If your sexual partner is not treated, this increases the risk of reinfection.

Prevention
If you’ve had trichomoniasis and it’s been treated, you will not be immune to the infection and could get it again.

Like any sexually transmitted infection (STI), the best way to prevent trichomoniasis is to have safe sex. This means always using a condom.

The following measures will help protect you from trichomoniasis and most other STIs, including chlamydia and gonorrhoea. They’ll also help prevent you passing it on to your partner:

use condoms (male or female) every time you have vaginal or anal sex
if you have oral sex, cover the penis with a condom or the female genitals with a latex or polyurethane square (a dam)
if you’re a woman and rub your vulva against your female partner’s vulva, one of you should cover your genitals with a dam
avoid sharing sex toys – if you do share them, wash them or cover them with a new condom before anyone else uses them
If you’re not sure how to use condoms correctly, you can read about how to use a condom.

If you’ve been diagnosed with trichomoniasis, make sure both you and your partner are treated, and that any sex toys you’ve used are cleaned.

Getting tested
If you’re sexually active, go for regular sexual health check-ups. You can get an appointment by visiting your local genitourinary medicine (GUM) clinic.

Find a sexual health clinic

If you notice any signs or symptoms of an STI, avoid having sex and visit a GP or GUM clinic as soon as possible.

Trichomoniasis
Stem- FY2 in GP. 19 years old male comes for routine
appointment.
Station flow
C/O - I come here for routine appointment because of
sexual partner notification system
History -
My ex-girlfriend was diagnosed with a sexually transmitted
infection. He gives out a paper written “Trichomonas”
No symptoms in this patient
Sexual history - unprotected sexual intercourse with his ex
for 3 weeks. Last sex was last week.
Concern - I don’t want to go to GUM clinic. I want to get
tested here. (Ask why?)
Concern - Is it STI only? Can it be transmitted in any other
route?
Concern - Can I just take antibiotics? My ex had STI
screening. It just shows trichomonas.
Data gathering
Explore STI and UTI symptoms like dysuria,
discharge, swelling, soreness around genital
areas
● FLAWs
● Explore sexual history- sexually active or not,
practice safe sex or not, any other partners, how
long have they been in relationship, any previous
partner in 6 months
● P2
● DESA
● MAFTOSA
Examination- GPE, Vitals, Urine dipstick test
Management
● Refer to GUM clinic- next day walk in appointment.
● They might offer urethral swabs, urine culture and
microscopy if needed.
● Other STI screening like gonorrhoeal, chlamydia, HIV,
syphilis.
● If one partner is tested positive, the other partner also
needs treatment at the same time- that’s why he will
be offered antibiotics regardless of any symptoms.
● He will be given Metronidazole 2 G single dose oral or
500 mg BD for 5-7 days.
● Advice for safe sex practice.
● Concern - I don’t want to go to GUM clinic. I want to
get tested here. (Ask why?)-GP can arrange swab
b
test and give treatment if patient keen on not going to
GUM clinic
● Concern - Is it STI only? Can it be transmitted in any
other route?-Mostly transmitted through contact with
genital discharge including penetrative sex and
sharing sex toys. Rarely, it can be transmitted through
sharing bath towels with those who has infection
● Concern - Can I just take antibiotics? My ex had STI
screening. It just shows trichomonas-It is advisable to
have STI screening to get to know other STI like
gonorrhoeal, chlamydia, HIV, syphilis

Trichomoniasis
Prompt: You’re FY2 in GP
19 years old male comes for routine appointment. Talk to him and address his concerns.
Station flow:
C/O-I am here for a routine
appointment
because my ex girlfriend told me
she had a sexually transmitted infection. Pt will hand
over a paper with the words Trichomoniasis written o n it.
History of symptoms:
How is your ex girlfriend doing? What symptoms does she have?

Do you have any symptoms? Any penile
discharge? Any pain on urination? Any swelling? Any genital soreness?
FLAWS
Sexual history:
Are you sexually active? Yes
Do you use protection and by that Imean condoms? No
When was your last sexual encounter with your ex? Last sex w a s last week.
Any other sexual partners in last 6 months? No
PS, DESA, MAFTOSA, ICE
Examination- GPE, Vitals, Urine dipstick test. All normal
Management:
Thank you for speaking to me and allowing me examine you. You don’t seem to have
any features of the condition although you
noted last sex was a week ago and treatment is advised if last sex w a s within
last 3 weeks.
• Refer to GUM clinic- next day walk in appointment.
. They might offer urethral swabs, urine culture and microscopy if needed.
• Other STI screening like gonorrhoeal,
chlamydia, HIV and syphilis.
• fI one partner is tested positive, the other partner also needs treatment at the same
time- that’s why he will
be offered antibiotics regardless of any
symptoms.
• He will be given Metronidazole 2 grams
single dose oral or 500 mg BD for 5-7 days. • Advice for safe sex practice.

Concern:
I don’t want to go to GUM clinic. I want to get tested here. (Ask why?)-GP can arrange swab test and give treatment patient keen on not going to GUM clinic.
Concern:
Is it STI only? Can it be transmitted in
any other route?-Mostly transmitted
through contact with genital discharge
including penetrative sex and
sharing sex toys. Rarely, it can be
transmitted through sharing bath towels
with those who has
infection.
Concern:
Can Ijust take antibiotics? My ex had
STI screening. It just shows trichomonas-lt is advisable to have STI screening to get to know other STls like HIV.