Trichomoniasis Complications

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Although trichomoniasis had long been regarded as a sexually transmitted infection of minor importance, evidence recently accumulated implicates Trichomonas vaginalis as a contributor to a variety of adverse outcomes in both women and men.1

Health Consequences of Trichomoniasis in Women

Risk Factor for HIV

T. vaginalis has been associated with amplifying transmission and aquisition of HIV infection.2 Treatment of women infected with T. vaginalis resulted in a 4.2-fold reduction in the quantity of HIV-1 in vaginal secretions.3

Associated with Herpes Simplex Virus-2 Acquisition

Incident trichomoniasis was an independent predictor of herpes simplex virus-2 incidence; women with trichomoniasis were almost 4 times as likely to acquire HSV-2 infection.4

Contributor to Female Infertility

Trichomonads may serve as vectors for spread of other organisms by carrying these pathogens up the fallopian tubes.5 Several studies have shown T. vaginalis to be a risk factor for tubal infertility.6-8

Pelvic Inflammatory Disease (PID)

A significantly higher rate of pelvic inflammatory disease among women with trichomoniasis has been shown compared with uninfected women.9 A separate study demonstrated that women colonized with Chlamydia and Trichomonas were significantly more likely to have symptomatic upper tract disease.10

Cervical Neoplasia

Infection with T. vaginalis has been associated with a 2-fold increased risk of cervical neoplasia, even after controlling for human papillomavirus (HPV) infection.11

Preterm Birth

Pregnancy complications such as preterm labor and delivery, as well as low birth weight infants have been associated with T. vaginalis infection in several studies.12,13 Treatment of asymptomatic trichomoniasis in pregnancy is controversial.14,15

Health Consequences of Trichomoniasis in Men

Risk Factor for HIV

Among HIV positive men with symptomatic Trichomonas urethritis, there was a 6-fold increase in HIV concentration in semen compared to HIV positive men without Trichomonas.16 Treatment of HIV infected men with T. vaginalis resulted in reduced excretion of HIV in semen.17

Contributor to Male Infertility

Among men infected with Trichomonas, there was a significant decrease in both sperm motility and viability versus control subjects. Treatment of Trichomonas showed significant improvements in sperm motility, viability, viscosity and particulate matter.18

Nongonococcal Urethritis (NGU)

Trichomoniasis may be an important cause of nongonococcal urethritis. A recent study found that in men with NGU, 19.9% were infected with Trichomonas.19 The Centers for Disease Control STD treatment guidelines recommend inclusion of Trichomonas therapy for men with recurrent NGU.20

Chronic Prostatitis

A recenty study involving men with chronic prostatitis found that in 71% of the men the cause of prostatitis was infective with trichomoniasis the specific infection in 19% of the men.21

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  11. Gram IT, Macaluso M, Churchill J, Stalsberg H. Trichomonas vaginalis (TV) and human papillomavirus (HPV) infection and the incidence of cervical intraepithelial neoplasia (CIN) grade III. Cancer Causes Control. 1992 May;3(3):231-6.
  12. Minkoff H, Grunebaum AN, Schwarz RH, Feldman J, Cummings M, Crombleholme W, Clark L, Pringle G, McCormack WM. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol. 1984 Dec 15;150(8):965-72.
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  14. Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, Ernest JM, Heine RP, Wapner RJ, Trout W, Moawad A, Leveno KJ, Miodovnik M, Sibai BM, Van Dorsten JP, Dombrowski MP, O'Sullivan MJ, Varner M, Langer O, McNellis D, Roberts JM; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001 Aug 16;345(7):487-93.
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  16. Hobbs MM, Kazembe P, Reed AW, Miller WC, Nkata E, Zimba D, Daly CC, Chakraborty H, Cohen MS, Hoffman I. Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis. 1999 Aug;26(7):381-7.
  17. Price MA, Zimba D, Hoffman IF, Kaydos-Daniels SC, Miller WC, Martinson F, Chilongozi D, Kip E, Msowoya E, Hobbs MM, Kazembe PN, Cohen MS. Addition of treatment for trichomoniasis to syndromic management of urethritis in Malawi: a randomized clinical trial. Sex Transm Dis. 2003 Jun;30(6):516-22.
  18. Gopalkrishnan K, Hinduja IN, Kumar TC. Semen characteristics of asymptomatic males affected by Trichomonas vaginalis. J In Vitro Fert Embryo Transf. 1990 Jun;7(3):165-7.
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  20. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR 2006;55(RR11):1-94.
  21. Skerk V, Schönwald S, Krhen I, Markovinovic L, Beus A, Kuzmanovic NS, Kruzic V, Vince A. Aetiology of chronic prostatitis. Int J Antimicrob Agents. 2002 Jun;19(6):471-4.