Trichomonas sp.

? What’s in a name
:From the Greek
trichos, hair 
monas, unit, single 

Trichomonads in vaginal
discharge first
described by Alfred
Donné in 1863 Medical Parasitology, 3rd. edition. Edward K.
Markell & Henrietta Voge.
Filmstrip II, Frame 34
 Objective of the lecture
By the end of this lecture the student should be able

to:
Describe the general features of Trichomonas sp and

G.D
Discuss the transmission and life cycle

Out line the general pathological effect

Describe the Lab. Diagnosis of Trichomonas sp

Prevention and control Trichomonas sp

 .Trichomonas sp

At least three species of protozoa of the genus

Trichomonas can parasitize humans, but only
Trichomonas vaginalis causes disease

Trichomonas tenax
Trichomonas hominis
Trichomonas vaginalis : causes
Trichomoniasis
 Trichomonas vaginalis
Geographical distribution: World wide
* Common sexually transmitted protozoon.
* Common at the age of 16-35 (sexually active period)
* More pathogenic in women than men
*T. vaginalis is concomitant with other pathogenic organisms.

NOTE:
1- Suitable pH for the parasite is 5.5 – 6 (low acidic).
2- Rare among young girls / menopause women - parasite
requires estrogenized epithelium for survival.
3- High in population at high risk for other venereal
diseases & poor feminine hygiene.
NOTE: Normal acidity is due to the action of bacillus on
glycogen content of vaginal epithelial cells producing
lactic acid.

Dr. RAAFAT MOHAMED

species of Trichomonas occur in humans 3
 Trichomonas vaginalis infection
Trichomonas vaginalis is a Facultative
anaerobe flagellated protozoa.
A sexually-transmitted urogenital
parasite..
Causes Trichomoniasis in humans
. Found in urogenital tract in both sex. :
- (vagina & urethra in females).
- (urethra, seminal vesicles & prostate in
males).
Common: cause of vaginitis disease.

Doesn’t have cyst form and exists only in

trophozoite stage

Extracellular - adheres to epithelia,

cause erosion to the Ep.tiss.

5.5 to 6.0 is optimum pH for the organism.

Normal vaginal environment its less /equa
than 4
 1. Morphology
1.1
Trophozoite
Pear-shaped and actively motile, 14-17 µm X 5-15 µm.

Four anterior flagella

A single
nucleus Axostyle

An undulating
membrane
Trichomonas vaginalis
Five flagella: arise near the
cytostome; four of these
Trichomonas vaginalis
immediately extend outside the
cell together, while the fifth
flagellum wraps backwards
along the surface of the
organism (UM).
Nucleus is anterior.
Axostyle: commences at the
nucleus and bisects the parasite.

Trophozoit only
.No cystic stage
Four anterior
flagella

The undulating
membrane
 Transmission of Trichomoniasis
_ Transmitted primarily by sexual intercourse.
intercourse
_ May also be transmitted through contaminated
toilet seats and linens (usually in children).
_ Rare instance of neonatal infections acquired at
birth (during the pass the baby through
birth canal).
1.2 Life cycle

Only trophozoite stage in life cycle.

Women: vagina and urethra

Trophozoites
Men: urethra or prostate, testes,
epididymis

The infection is acquired by sexual activity or

some indirect ways
 Only trophozoites
in life cycle, no
cyst stage

The infective
stage is
trophozoite

The trophozoites
multiply by
binary fission
Pathogenesis and Symptoms

The pathogenic ability has close

relationship withT. vaginalis strains and
host’s physical state.
The vaginal secretions,
pH 3.8-4.4
Women Non-pathogenic
under
normal
condition Control the growth
and reproduction of
the parasites
 Women under some conditions (during
.pregnancy, menses, etc
Reduction in acidity of vagina

The trophozoites multiply by binary fission

Mild to severe vaginitis, with a yellow-green purulent

foul-smelling discharge,
associated with burning and itching. The vaginal mucosa
is sometimes diffusely hyperemic.

Frequency of urination and dysuria are the commonest

associated symptoms; cystitis may occur in a small
.portion of the cases
 Asymptomatic carriers
Male
infection

When the infection involves the prostate

and seminal vesicles or higher parts of
urogenital tract, a thin discharge,
frequently containing Trichomonas, with
dysuria and nocturia. The prostate may
be enlarged and tender, associated
epididymitis.
 Trichomoniasis
Clinical Symptoms
Vaginitis, irritation, burning , itching, pain &
watery foul smelling greenish yellow copious
discharge , pus.
Vaginal walls swollen: vaginal erythema ,
eroded, microhemorrhages .
Possible: urethritis, cystitis, dysuria, cervicitis
Incubation period is 5 - 28 days .
In men are asymptomatic but
may exhibit prostatitis ,urethritis.
 Complication
1- Ectopic pregnancy
2- Infertility
3- premature rupture of fetal membranes
4- low birth weight .
5- Endometritis .
6- Cervical carcinoma .

20
 Diagnosis of Trichomoniasis
Clinically
Laboratory
Colposcopy
Normal Cervix
Dens, bad odour, foamy,
green yellow discharge

Erythema and
strawberry cervix
 Laboratory diagnosis of
Trichomoniasis
 1-Measuring the vaginal pH. pH – litmus
paper
 2- Potassium hydroxide amine test .
 3- Saline microscopic examination.
 4- smear stain (giemsa stain)
 5- Cultures.
 6- Polymerase chain reaction.
Culture is the most sensitive
method, but needs 3-7 days
: Potassium hydroxide amine test (Whiff test) -2
Upon application of 10% potassium hydroxide (KOH) to
a vaginal swab sample, a fishy odor is released,
which can suggest trichomoniasis or bacterial
.vaginitis
Whiff test : 10 % KOH
3. Saline microscopic examination
Finding trophozoites

In women: vaginal discharge and urine

In the male: urethral discharge ,

prostates secretions, centrifuged urine.
 :Saline microscopic examination
Microscopic examination of wet vaginal discharges,
urethral discharges, or urine for motile trichomonads.
In women, Trichomonas vaginalis is isolated from the
vagina, cervix, urethra, bladder,
Trichomonas, which are ovoid-shaped parasites, may be
identified by their jerky mobility.
Trichomonad cause an inflammatory reaction; therefore, a
large number of PMNs (pus cells) usually are
present as severity of the infection .
Urinalysis

can reveal pH or water concentration

imbalances, the presence of glucose or proteins
and other conditions associated with infections,
metabolic disorders, and other diseases
 prevention

by :
1- safe sex practices
2- prevent using toilet equipment can
reduce transmission
4. Epidemiology

4.1 Distribution

Worldwide distribution

The infection rate is high, especially among the

women (age from 20 to 40 years old)
 Trichomonas Hominis-1
 Geog. Distribution: all over the world, more
in worm areas.
 Habitat: in the large intestine especially
caecum of human.
 Morphology:

Trophozoite: Same as T. vaginalis.

 .Movement: Jerky
.Cyst: No cyst stage
Transmission: perhaps by ingestion of the flagella
.form
.Infection/pathogenesis: not known
:Diagnosis
.Wet preparation.1
.Seroimmnunological investigations.2
culture .3
Life Cycle of Trichomonas hominis
1. Trophozoites live in the
human large intestine and
multipy by binary fission.

2. Dehydration of the feces in

the large intestine caused the
trophozoite to round up and
become dormant. No cyst is
formed.

3. Trophozoites are released

in the feces and survive in
water in the external
environment.

4. When trophozoite is
ingested, it passes down the
digestive tract to the large
intestine.
Specimens:
blood or stool.
1. Wet preparation of stool in saline to see the active
motile forms (we should examine it quickly).
2. Iodine preparation to differentiate of the
morphology characters.
3. Seroimmnunological investigations (agglutination
& haemoagglutination
 .Genus: Chilomastix -3
 Spc: C. mesnili.
 Geog. Distribution: all over the world.
 Habitat: in the caecal area of the large intestine.
 Morphology:
 Trophozoite: pear form.
 Size: 7-10µm in length.
 4 flagella, 3 forewords, 4th in the cleft.
 Cyst: pear form, 8µm, single nucleus.
Chilomastix mesnili life cycle
1. When cyst is ingested, it
excysts in the small intestine
and moves to the large
intestine.

2- Trophozoites live in the human

large intestine and multipy by
longutidanal binarry divission

3. Cyst survives in water in the

external environment.
 Transmission: ingestion of cyst in
contaminated food and drink.
 Pathogenicity: none (if present with large
numbers, may be result in some disturbance).
 Diagnosis:
 Specimens: stool.
1-In saline and iodine preparation: cyst and
flagellated forms are found in stool, the
movement is Rotary.
2-Culture: in laboratory media.
Chilomastix mesnilii.flv