Trichomoniasis

1 What is Trichomoniasis?

Trichomoniasis, or the ‘trich’, is an infectious disease often considered a sexually-transmitted infection. It is caused by the parasite called Trichomonas vaginalis. Although both men and women can get trichomoniasis, the disease places more burden on women.

The exact prevalence of trichomoniasis is somewhat difficult to determine. That’s because it does not always cause symptoms. The Centers for Disease Control estimates that it affects an estimated 3.7 million people in the US. It is one of the most common sexually transmitted infections worldwide.

Although Trichomonas vaginalis was first discovered in 1883, its role in causing disease was not fully understood until 1940s. By the time of its discovery, researchers thought that it was common and harmless. At that time, doctors were more focused on age-long sexually transmitted diseases like syphilis and gonorrhea.

Among sexually transmitted infections, trichomoniasis is the most curable. However, infection makes you more vulnerable to HIV infection. Trichomoniasis is also known to cause problems in pregnancy. Those complications make trichomoniasis a public health concern. The good thing is that almost all patients recover completely with treatment.

2 How do you get trichomoniasis?

The protozoan parasite Trichomonas vaginalis causes trichomoniasis. It is a microscopic organism too small to see by the naked eye. Humans are the only host of the parasite, which means you cannot get it from touching surfaces or from food. Trichomonas vaginalis is a protozoan, and it is not a virus nor a bacterium. With that being said, most antibiotics and antivirals will not treat it.

Trichomonas vaginalis primarily spreads via direct skin-to-skin contact. It spreads to others commonly by vaginal sex. Its presence in areas near the rectum has been documented in very few cases, which may explain why it is less common in men who have sex with men. It has not been isolated in mouth secretions, so spread via oral sex is very unlikely.

Since Trichomonas spread via vaginal sex, you are most likely to acquire trichomoniasis through sex with infected female partners. It is much more common in African American women, and risk increases with age and number of sexual partners. Trichomoniasis is very common and often does not cause symptoms, so it is a risk to anyone having sex. According to data from United States CDC, it is more common in women and 85% do not have any symptoms at all.

The quantity of parasites needed to cause infection, according to experiments, is very low. That means you can contract trichomoniasis easily. One sexual encounter with an infected person may be enough to give you the infection.

Your risk of having trichomoniasis is higher if you have multiple sexual partners, have a pre-existing sexually transmitted disease (like chlamydia, gonorrhea, herpes, or HIV), or have sex without using a condom.

Note that having the condition does not make you immune to it. Therefore, you can have it recurrently. The condition is not self-limiting, and it will only go away with treatment.

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3 Symptoms of trichomoniasis

Although it does not cause symptoms in most people, trichomoniasis causes the characteristic frothy and greenish vaginal discharge with a musty malodorous odor. Women are more likely to experience symptoms than men, although the majority of them do not actually exhibit any symptoms.

Here are the trichomoniasis symptoms in women:

  • Itching, burning, or soreness of the vagina
  • Pain during urination
  • Having vaginal discharge, which can be clear, white or yellowish, or greenish with unusual fishy smell
  • Pain while having sex

Trichomoniasis symptoms in men may be different from women. A lot of men infected with Trichomonas do not exhibit any symptoms at all, so they are able to spread infection to others unknowingly.

If they ever experience symptoms, they may have the following:

  • Burning sensation when urinating.
  • Burning or itching sensation inside the penis.
  • Having discharge from the penis.
  • Burning pain in the penis during ejaculation.

As most cases do not cause symptoms, many people with trichomoniasis do not know they have the infection and therefore fail to receive proper medical care.

4 Long-term complications of untreated trichomoniasis

Many people choose not to seek treatment for trichomoniasis even though it is a highly curable condition. The condition itself does not become worse, but it cause serious risks. It is known to greatly increase the risk of having other sexually transmitted infections. Unfortunately, the long-term effects of trichomoniasis disproportionally affect women.

Trichomoniasis may increase your susceptibility to HIV infection. There are many studies showing that 10% to 20% of female patients with HIV also have trichomoniasis. It is estimated that having the disease makes women 50% more likely to acquire an HIV infection. The mechanisms are not completely clear, but doctors assume that the inflammation, upset flora in the vagina, or changes to cells in the body caused by Trichomonas infection may be the cause. It is not yet studied if these findings also apply to men.

Increased risk of HIV makes trichomoniasis a burden to individuals such as sex workers, sexual assault victims, and those with multiple sexual partners. The patient may acquire trichomonas from a partner, or in the case of sex workers, from infected clients. Note that the risk of HIV is significantly higher in those who have several sex partners. To HIV-positive patients, treating trichomoniasis may help reduce viral shedding or release of virus from the body.

Trichomonas is known to penetrate the placenta in pregnant women, giving them the ability to cause problems to the developing fetus. Pregnant women with trichomoniasis face greatly increased risk of having preterm birth and giving birth to a low-birth weight baby. Low birth weight babies face higher risk of having complications and so need specialized care. When it happens in the first trimester, Trichomonas may also increase risk of miscarriage. Contracting trichomoniasis poses a grave threat to the health of the pregnant mother and her child.

5 Diagnosing trichomoniasis

There are no quick or rapid tests to diagnose this condition. You really have to go to the doctor if you have any discharge in the penis, unusual discharge in the vagina, or have pain during sex or while urinating. All clinics are bound by law to respect your wishes and treat your medical information with confidentiality.

Most health care facilities are able to diagnose STDs. After a physical exam and assessment of your medical history, the doctor may ask for a sample of your discharge or urine. The vaginal fluid, or urine in men, is examined under a microscope for presence of Trichomonas but it has a significant false negative rate and results take some time. Newer tests such as rapid antigen tests and nucleic acid amplification can detect Trichomonas with higher detection rates, but they are not commonly used.

6 Trichomoniasis treatment

Trichomoniasis is a curable condition. Like in all sexually transmitted infections, treatment involves both you and sexual partner(s), which prevents the disease from spreading. Treating both partners helps totally eradicate infection.
The disease is treated by taking a single dose of either metronidazole or tinidazole. These drugs are special antibiotics that kill protozoans such as Trichomonas. Metronidazole is an older drug that has been in use for decades. However, many trichomoniasis cases have proven resistant to metronidazole. Tinidazole is a newer drug, and the one most likely to be prescribed by your doctor.

Before taking these drugs, make sure to tell the doctor if you have any allergies to metronidazole or to tinidazole, have a liver disease, have porphyria, anemia, or low white blood cell count, epilepsy, or nerve disorder. You cannot take metronidazole or tinidazole if you have these conditions. Also, you cannot take tinidazole if you are taking the drugs disulfiram, astemizole, busulfan, cisapride, or terfenadine.

For trichomoniasis, metronidazole and tinidazole are given in a one large dose only. If you are pregnant, you can take these drugs after the end of first trimester (after 12 weeks). If you are nursing, you have to stop breastfeeding your baby for a few days after taking the drug; your doctor will tell you when it is safe. In the meantime, you may express milk and throw it away so lactation will continue.

The disease is considered cured within a week of taking the drug. In the meantime, abstinence is needed because you and your partner may still have trichomonas in the body. You can resume having sex after a week of taking the drug.

You might want to know more about home remedies for trichomoniasis, if they are available. You may find many ‘test kits’ and herbal supplements advertised to diagnose and treat diseases including trichomoniasis. Unfortunately, these products are not proven effective or safe. You will only treat the condition by going to the doctor and taking the prescribed medication.

7 Trichomoniasis prevention

Since trichomoniasis is common and does not cause symptoms to patients, getting infected is not a remote possibility. The only ways to prevent infection is abstinence or practicing safe sex. Having a monogamous relationship with a trusted partner will also greatly reduce your risk. If you are abstinent, there is no way you can get trichomonas from others. If you have sex with only one person, and if that person will not have sex with anyone except you, your risk of having trichomoniasis and other sexually transmitted infections is slim to none.

If you really want to cut down your risk, think about reducing your sexual partners. Also, make sure to be open in discussing sexual histories and risk of infection. For women, avoid the practice of douching, which upsets the natural flora of the vagina that helps reduce likelihood of infection. You only have to wash the area around the vagina with unperfumed soap and plain water; no need to spray liquid upward of the vaginal canal.

One of the simplest and cost-effective method of preventing trichomoniasis and many sexually transmitted infections is using a condom. The condom forms a barrier that prevents transmission of bacteria, parasites, and viruses between sexual partners. It is only effective if used properly and consistently.

Most condoms sold today are male condoms, but you can also use a female condom. For the best protection, use a condom when having sex with someone who has multiple sexual partners. Wear it when having sex with a new partner or if you are having sex with someone who is having sex with someone else.

Since condoms may break, wearing it properly is just as important as using it often. You can reduce risk of breakage by applying lubricant on the condom and the penis; only use a water-based product as other types will cause the rubber on the condom to break down. Leave a small space in the tip when unrolling the condom on the penis. Make sure to use an appropriate-sized condom and always roll down all the way through. Always put a condom on before any sexual activity.

It is important to use a condom whenever having sex with a new partner, even if it will be only once. Make sure to have ready access to condoms. Do not store them in hot places, where the rubber may break down. If you have sex and forgot to wear a condom, or if the condom broke, make sure to get tested for sexually transmitted infections right away.

In case you suspect you or your partner may have trichomoniasis or other sexually transmitted infections, go to your doctor right away and get tested. Early testing is essential to prevent worsening and spread of infection. While you are receiving medical care, your health provider will do contact tracing, which involves informing your partners about risk of possible STI. It is a sensitive issue to anyone, so your health provider will give help; often, they will be the ones to contact the individual.

Everyone involved should be tested and receive treatment if necessary. Remember that early diagnosis and treatment of sexually-transmitted infections including trichomoniasis reduces likelihood of spread and complications.

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