A 32-years-old female patient is presented to the emergency department with a chief complaint of green, foul-smelling vaginal discharge accompanied by fever, nausea, vomiting, and lower back pain. A physical exam reveals no abdominal rigidity but reddened cervix, bilateral adnexal tenderness, and chandelier sign. Based on the presenting symptoms, the patient is quite likely to have a sexually transmitted infection, trichomoniasis. Though the patient insists that she only has sexual intercourse with her husband, there are other risk factors that she might not be aware of, such as her spouse’s sexual history.
Trichomoniasis is the most common sexually transmitted infection in the United States, with more than 3.7 million people infected at any given time (Centers for Disease Control and Prevention, 2020). The disease is caused by the parasite Trichomonas vaginalis (Tv) that, as an extracellular pathogen, can colonize the human host through adherence to epithelial cells. Apart from that, Tv invasion affects a host’s immune system and the vaginal microbiota in women, who are more vulnerable to developing trichomoniasis (Centers for Disease Control and Prevention, 2020).
Mielczarek and Blaszkowska (2016) explain that the parasite destroys host cells which leads to a disruption in her vaginal flora. The most common symptom of disruption is a vaginal discharge which often has unusual discoloration and a fishy smell, which is observed in the patient. It should be noted that the presence of Tv triggers an immune system response, leading to inflammation. The patient complains about fever and chills, which may be a sign of ongoing inflammation. This may also be observed in the patient’s laboratory test that demonstrates extremely high levels of C-reactive protein, a reliable marker of inflammation. At present, the woman’s C-reactive protein is 67 mg/L CMP wnl, while the norm is under 10mg /L.
Centers for Disease Control and Prevention (2020) states that it is not possible to diagnose trichomoniasis based on the symptoms and a blood test alone. Typically, a laboratory test for trichomoniasis includes sampling a patient’s vaginal fluid or urine (for men) and looking at it under a microscope. If Trichomonas vaginalis is detected, no further tests are needed. However, Šoba et al. (2015) write that sometimes, laboratory tests are not conclusive, in which case, one would have to resort to rapid antigen tests and nucleic acid amplification.
Both the patient and her spouse must get checked for trichomoniasis. Though trichomoniasis is easy to cure, if not tended to, it may lead to many complications. According to Tsevat et al. (2017), a significant share of female infertility, which is a public health concern worldwide, can be ascribed to tubal infertility. Oftentimes, if a woman does not check her sexual health status and get timely treatment for sexually transmitted diseases, the infection may ascend the reproductive tract. Such movement may result in tubal inflammation, damage, and scarring (Tsevat et al., 2017). Research has found that women with self-reported infertility had two- to trifold chances of having trichomoniasis at the same time (Tsevat et al., 2017). As for the patient’s spouse, he may be at a heightened risk of prostate cancer if he does not treat trichomoniasis. Kim et al. (2019) discovered that men with prostate cancer had higher seropositivity to Trichomonas vaginalis than healthy men. Leaving sexual infections untreated has long-term adverse effects, which is why the patient and her spouse need to take action.
Centers for Disease Control and Prevention. (2020). Trichomoniasis is common and easy to cure. Web.
Kim, J. H., Moon, H. S., Kim, K. S., Hwang, H. S., Ryu, J. S., & Park, S. Y. (2019). Comparison of Seropositivity to Trichomonas vaginalis between men with prostatic tumor and Normal men. The Korean Journal of Parasitology, 57(1), 21.
Mielczarek, E., & Blaszkowska, J. (2016). Trichomonas vaginalis: Pathogenicity and potential role in human reproductive failure. Infection, 44(4), 447-458.
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1-9.
Šoba, B., Skvarč, M., & Matičič, M. (2015). Trichomoniasis: A brief review of diagnostic methods and our experience with real-time PCR for detecting infection. Acta Dermatovenerol alp Pannonica Adriat, 24(1), 7-10.