Trichomonas vaginalis

Noreen A. Hynes, M.D., M.P.H., D.T.M.&H.
Trichomonas vaginalis is a topic covered in the Johns Hopkins ABX Guide.

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MICROBIOLOGY

  • Trichomonas vaginalis (TV): 5-15 µm, pear-shaped, motile, flagellated protozoan parasite.
    • Exists in the trophozoite stage only [Fig. 1; life cycle].
      • Facultative anaerobe, divides by binary fission.
      • Optimal growth in moist milieu at a pH of 4.9-7.5 and a temperature of 35oC-37oC.
    • Trichomonads gather in clusters on the stratified urogenital epithelium, covering only a small surface area.
      • Parasites invade superficial epithelium causing damage directly beneath the clustered trichomonads.
      • Non-specific inflammatory response noted in the lamina propria with plasma cells, lymphocytes, and neutrophils present.
      • Superficial ulceration of the epithelium can occur.
    • A depressed level of secretory leukocyte protease inhibitor (SLPI) in cervicovaginal fluid, seen more often in females receiving hormonal contraceptives and those with vaginal pH >4.5, correlates with both T. vaginalis infection and poor reproductive outcomes in women
  • Transmission issues:
    • Can survive up to 45 minutes on clothing, washcloths, and in bath water.
    • Presence of infection enhances acquisition of HIV infection.
    • Antecedent bacterial vaginosis (BV), as defined by Nugent criteria, is a risk factor of T. vaginalis acquisition.
      • T. vaginalis is strongly associated with an INTERMEDIATE Nugent score (0-3 = Normal, 4-6 = Intermediate, >6 = BV)
      • T. vaginalis is strongly associated with an uncultivated member of the genus Mycoplasma which appears less pro-inflammatory than M. hominis.

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MICROBIOLOGY

  • Trichomonas vaginalis (TV): 5-15 µm, pear-shaped, motile, flagellated protozoan parasite.
    • Exists in the trophozoite stage only [Fig. 1; life cycle].
      • Facultative anaerobe, divides by binary fission.
      • Optimal growth in moist milieu at a pH of 4.9-7.5 and a temperature of 35oC-37oC.
    • Trichomonads gather in clusters on the stratified urogenital epithelium, covering only a small surface area.
      • Parasites invade superficial epithelium causing damage directly beneath the clustered trichomonads.
      • Non-specific inflammatory response noted in the lamina propria with plasma cells, lymphocytes, and neutrophils present.
      • Superficial ulceration of the epithelium can occur.
    • A depressed level of secretory leukocyte protease inhibitor (SLPI) in cervicovaginal fluid, seen more often in females receiving hormonal contraceptives and those with vaginal pH >4.5, correlates with both T. vaginalis infection and poor reproductive outcomes in women
  • Transmission issues:
    • Can survive up to 45 minutes on clothing, washcloths, and in bath water.
    • Presence of infection enhances acquisition of HIV infection.
    • Antecedent bacterial vaginosis (BV), as defined by Nugent criteria, is a risk factor of T. vaginalis acquisition.
      • T. vaginalis is strongly associated with an INTERMEDIATE Nugent score (0-3 = Normal, 4-6 = Intermediate, >6 = BV)
      • T. vaginalis is strongly associated with an uncultivated member of the genus Mycoplasma which appears less pro-inflammatory than M. hominis.

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Last updated: July 24, 2019