Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Trichomoniasis


Related Terms

  • Trich

Differential Diagnosis

Specialists

  • Family Physician
  • Gynecologist
  • Infectious Disease Internist
  • Urologist

Comorbid Conditions

  • Immune system disorders

Factors Influencing Duration

The severity of infection and effectiveness of treatment influence the length of disability. Factors related to reinfection also influence length of disability and include the number of sexual partners, the infection status of sexual partners, and condom use. Individuals with compromised immune systems may have delayed recovery. Treatment is normally delayed during the first trimester of pregnancy.

Medical Codes

ICD-9-CM:
131.00 - Trichomoniasis, Unspecified Urogenital; Fluor (Vaginalis) Trichomonal or Due to Trichomonas (Vaginalis); Leukorrhea (Vaginalis) Trichomonal or Due to Trichomonas (Vaginalis)
131.01 - Trichomonal Vulvovaginitis; Vaginitis, Trichomonal or Due to Trichomonas
131.02 - Trichomonal Urethritis
131.03 - Trichomonal Prostatitis
131.09 - Trichomoniasis, Urogenital, Other
131.8 - Trichomoniasis, Other Specified Sites
131.9 - Trichomoniasis, Unspecified

Overview

Trichomoniasis is a sexually transmitted infection (STI) caused by a single-celled protozoan parasite called Trichomonas vaginalis. Infection with this organism produces disease ranging from no symptoms to severe inflammation. In women it causes inflammation of the vagina (vaginitis). In men, it can cause inflammation of the prostate, urethra, and seminal vesicles. Up to half of all infected women and the majority of infected men show no symptoms.

Trichomoniasis is spread through contact with discharge from the vagina or urethra from an infected individual during sexual intercourse. Even if no symptoms are present, an infected individual can continue to spread the disease as long as he or she carries the organism.

Trichomoniasis is often seen in combination with other STIs. Up to 40% of individuals with trichomoniasis also have gonorrhea. Trichomoniasis makes an individual more vulnerable to HIV infection when exposed. In individuals already infected with HIV, trichomoniasis increases the likelihood of spreading HIV to a partner.

Incidence and Prevalence: The prevalence of trichomoniasis in the US is estimated to be 3.7 million, with older women (> 35) having the greatest percentage 2.3 million (3.1%) among women ages 14-49 ("Trichomoniasis - CDC Fact Sheet"). An estimated 20% of American women have the infection at least once during their reproductive years. In the US, trichomoniasis is present in 72% of male sexual partners of infected women (Smith). Trichomoniasis is found worldwide in all races. About 170 million individuals are infected. The rate of infection varies from region to region: the rate in Europe is comparable to that in the US, but infection rates in Africa are higher.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Trichomoniasis affects far more women than men. Individuals with multiple sex partners are most at risk of developing this infection. Women between the ages of 16 and 35 are most commonly affected; however, trichomoniasis becomes more common with age and lifetime number of sexual partners. In comparative studies of accurate molecular amplification testing the highest rate of trichomoniasis is found in women ages 36 to 40 (Gincchino). Individuals with other STIs, especially gonorrhea, are more likely to have a trichomoniasis infection. Use of condoms reduces the risk of infection.

Other risk factors include high-risk sexual practices (multiple partners, unprotected sex), low socioeconomic status, substance abuse, and a history of bacterial vaginosis.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms usually develop 5 to 28 days after exposure to the infection (incubation period). The infected individual's history includes contact with an infected individual or multiple sexual partners. Women have a foul-smelling, thin, greenish-yellow, foamy vaginal discharge. Often there is pain or burning during urination (dysuria) or sexual intercourse (dyspareunia). Some women experience irritation and itching in the vaginal area or lower abdominal pain, but other women are asymptomatic. Men's symptoms are often absent (> 75%) or mild. They may experience pain or burning during urination or ejaculation. Some individuals carry the organism for years, yet have no symptoms.

Physical exam: The physical exam of a woman confirms vaginal discharge and reveals red vaginal ulcers. The vulva or vagina may be inflamed. Severe cases may also show inflammation of the cervix. In males, inflammation of the prostate (prostatitis), urethra (urethritis), urinary bladder (cystitis), epididymis and testis (epididymo-orchitis), or seminal vesicles (seminal vesiculitis) may be detected. There may be a discharge from the urethra in men and women.

Tests: Trichomoniasis is identified through examination of vaginal or urethral discharge under a microscope (wet mount microscopy). Because the causative organism may not be detected in every specimen, several specimens may be needed. The organism may also be cultured from vaginal or urethral discharge; culturing is especially important in the diagnosis of asymptomatic men. Antigen detection, and nucleic acid amplification test (NAAT) may also be used. Immunologic blood tests for T. vaginalis are positive in 90% of infected individuals.

Because of the close association of trichomoniasis and other STIs, tests for gonorrhea, Chlamydia, syphilis, and HIV, as well as bacterial vaginosis, should be performed at the same time.

Source: Medical Disability Advisor



Treatment

Trichomoniasis is typically treated with an antiprotozoal agent, usually metronidazole or tinidazole. The drug is taken either in a single dose or over a period of 7 days. Alcohol must be avoided while taking this medicine because of side effects such as cramping. If initial treatment fails, higher drug concentrations are used for a second round of treatment. Drug treatment should be avoided in the first trimester of pregnancy.

The infected individual should abstain from sex until treatment is completed and symptoms disappear. All sexual partners should be treated at the same time.

Source: Medical Disability Advisor



Prognosis

The prognosis for treated trichomoniasis is excellent. The cure rate is 90% if all sexual partners are treated at the same time. If any sexual partner is not treated, reinfection is likely.

Drug resistance of T. vaginalis is uncommon. Individuals infected with resistant strains need a higher-dose regimen or the use of a different drug.

Source: Medical Disability Advisor



Complications

Chronic trichomoniasis may cause cellular changes that can be misinterpreted on a Pap smear, and may play a role in cervical neoplasia. Women with trichomoniasis have a higher risk of pelvic inflammatory disease (PID), and tubal infertility. Trichomoniasis increases the risk of transmission of HIV to women, and of vertical transmission of HIV from mother to fetus. Trichomoniasis during pregnancy can cause premature rupture of membranes (PROM), premature birth (preterm delivery), low birth weight infant, and intrauterine infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or accommodations are required for this diagnosis.

Risk: Because trichomoniasis is transmitted solely through sexual intercourse, there is no risk to coworkers. Similarly, infected individuals are not at risk for worsened symptoms because of workplace duties.

Capacity: Capacity is unaffected by this disease. Very rarely, infected females may experience minor discomfort of inflamed or ulcerated vaginal tissues during prolonged sitting, which can be offset by wearing loose-fitting clothing.

Tolerance: Tolerance is not an issue for individuals with this diagnosis.

Source: Medical Disability Advisor



Maximum Medical Improvement

10 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did the woman present with symptoms of foul-smelling, purulent vaginal discharge and associated dysuria and dyspareunia?
  • In males, were symptoms of pain or burning during urination or ejaculation noted?
  • Was the diagnosis confirmed by positive vaginal or urethral cultures?
  • Were other conditions with similar symptoms, such as bacterial vaginosis, vulvovaginal candidiasis, chemical vaginitis, epididymitis (in males), gonorrhea (in males and women), pelvic inflammatory disease (in women), and urethritis (usually in males), ruled out?

Regarding treatment:

  • Was the individual treated with an appropriate oral antiprotozoal agent?
  • Did the symptoms persist despite treatment? If so, were appropriate changes or adjustments in the drug therapy made?
  • Did individual take all medication as prescribed?
  • Was the individual compliant in abstaining from alcohol use during drug treatment?
  • Was individual instructed to abstain from sex until infection has resolved to prevent disease transmission?
  • Were all sexual partners treated simultaneously to prevent disease transmission?

Regarding prognosis:

  • Did the infection persist despite treatment?
  • Were appropriate adjustments made in drug treatment?
  • Has individual experienced any complications, such as chronic trichomoniasis or epididymitis, that may affect recovery and prognosis?
  • Does individual have any existing conditions (pregnancy, HIV, or other STIs) that may complicate treatment and affect recovery?

Source: Medical Disability Advisor



References

Cited

"Trichomoniasis - CDC Fact Sheet." CDC. 28 Apr. 2015. Centers for Disease Control and Prevention. 22 Jul. 2015 <http://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm>.

Gincchino, C. C. , et al. "Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States." Journal of Microbiology 50 8 (2012): 2601-2608. National Institutes of Health (NIH). National Institutes of Health (NIH). 22 Jul. 2015 <http://www.ncbi.nlm.nih.gov/pubmed/22622447>.

Smith, D. S. , and Natalia Ramos. "Trichomoniasis." eMedicine. 14 Sep. 2011. Medscape. 22 Jul. 2015 <http://emedicine.medscape.com/article/230617-overview#showall>.

Source: Medical Disability Advisor






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