Women's Health

Trichomoniasis: What You Need to Know

Trichomoniasis: What You Need to Know

Key Takeaways

  • Trichomoniasis is the most common sexually transmitted infection (STI) that is caused by a parasite rather than a virus.
  • Trichomoniasis is a preventable and curable type of STI.
  • A pregnant woman with any signs of trichomoniasis should call the doctor immediately.

What is trichomoniasis?

Trichomoniasis or "trich" is a common infection of the reproductive organs. It spreads by sexual contact with the infected person. For this reason, it is a type of sexually transmitted infection (STI). Women are invariably at greater risk. However, the infection is not exclusive only to women. Men who have unprotected sex with an infected partner can get it. However, the infection in men mostly goes unnoticed.

Although it is one of the most common sexually transmitted infections (STIs), there is still a lack of its awareness. Additionally, a higher rate of underdiagnosis further reduces the event of a successful treatment.

However, it is good to know that it is a curable and preventable type of STI.

What causes trichomoniasis?

The causative agent of trichomoniasis is the flagellated parasite called Trichomonas vaginalis. It is a single-celled protozoan that resides in women's vagina and urethra. For this reason, a number of women with an active infection also develop urethral infections.

How to recognize trichomoniasis

Identifying trichomoniasis is essentially not an easy task. The reason is that the signs of trichomoniasis often overlap with those of other conditions. Most commonly, bacterial vaginosis, which is another infection of the vagina, is really close when it comes to its physical manifestations.

Following an exposure, the infection may take up to a month to become noticeable. Take extra care if you indulge in frequent sexual activities. If you are a female, watch out for the following signs:

  • A bad-smelling yellowish discharge from the vagina. Depending on specific cases, a trichomoniasis discharge can be thick and large in amount or thin and only come in small amounts.
  • Inflammation and itching in the areas near the vagina.
  • Pain or discomfort in the lower region of the abdomen.
  • Strawberry cervix is another common sign of trichomoniasis in women, wherein red lesions are formed in the cervix and vaginal walls.

On the other hand, most men will not develop any noticeable symptoms even if they have already contracted the causative organism. Painful urination in men and an unusual discharge from the penis may indicate an active infection. However, further tests can only confirm the diagnosis.

When to seek help

Not all cases of trichomoniasis are dangerous. Nonetheless, there are certain conditions or signs that may be pointing toward a potential health complication. They include:

1) Pregnancy

A pregnant woman with any signs of trichomoniasis should call the doctor immediately. There is no benefit in delaying a professional consultation at this sensitive time.

2) Fever along with lower abdominal pain

When you experience pain in the lower part of your tummy and have a fever, consult your doctor immediately for a proper diagnosis and treatment.

What are the tests for trichomoniasis?

Only evaluating the signs and symptoms of trichomoniasis are not enough to confirm the diagnosis. For this reason, doctors usually recommend further tests. They include:

1) Vaginal swabs - Doctors take a sample of the vaginal discharge using a cotton swab. The vaginal swab is then sent to the laboratory for further testing to identify the infection's causative agent.

2) Urinalysis - For male patients, analysis of the first urine in the morning may give a confirmatory result. This is called as the “first-void” urine analysis.

3) Nucleic acid amplification test (NAAT) -  A very sensitive and sophisticated test that gives a more accurate diagnosis. Talk with your doctor if the test is suitable for you.

Quick facts on trichomoniasis

  • Globally, trichomoniasis is the most common sexually transmitted infection (STI) that is caused by a parasite rather than a virus.
  • Metronidazole and the similar medication tinidazole are the standard treatments for trichomoniasis. These medications are orally given.
  • According to the Centers for Disease Control and Prevention (CDC), approximately 3.7 million Americans have it. However, only 30 percent of them report the symptoms.
  • Twenty percent of trichomoniasis patients who were successfully treated get a second infection within the next few months.
  • The infection is more common in women than in men. Additionally, older women are at a greater risk. The age range for women to contract the infection is 14-49 years old.
  • Every year in the US, approximately one million new cases are added.
  • A patient with Trichomonas is six times at higher risk of getting syphilis compared to a person without it. In the case of an HIV infection, the risk is multiplied by 13 times. Likewise, the risk of having pelvic inflammatory disease (PID) is increased by two folds.
  • Age, race, and age at the first sexual encounter are the top risk factors for trichomoniasis in men.
  • There are reports of its transmission to the infant from an infected mother.
  • Trichomoniasis costs US women approximately $19 million per year. In the same way, the health costs of other potential complications go past the billion dollar mark.

Latest updates on trichomoniasis

Women may be naturally in a better position to fight the Trichomonas parasite. Researchers at the University of Auckland, New Zealand suggest that the “lactic acid” in the vagina may provide an inherent protection against T. vaginalis. They believe that this natural body defense could lead to further developments in the treatment of trichomoniasis.

Older women may be at a greater risk than women in their 20s. In fact, investigators recommend a routine screening test for all sexually active women who are 40 years old and above.

The Centers for Disease Control and Prevention (CDC) has recently put trichomoniasis in the list of the top 5 parasitic infections that require special care. The others in the list are Chagas disease, cysticercosis, toxocariasis, and toxoplasmosis. As a matter of fact, parasitic infections do not garner much attention like bacterial and viral infections do. Nevertheless, they pose significant health risks and an economic burden. A change in health priorities mean that we can expect more funding for research activities to provide better treatment options.

Why are metronidazole and tinidazole not working against trichomoniasis?

1) Failure to comply with the dosing instructions

Treatment failure is more likely to happen if you do not follow the instructions from your doctor. Taking incorrect doses of antibiotics may not achieve the desired results.

2) An infection that returns after recovering from the first infection

A recurrent infection does not respond well to metronidazole.

3) No treatment of sexual partners

Treating your partner is of high importance to avoid a reinfection. In fact, both you and your partner should get treated at the same time.

4) Drug resistance

There is an increasing evidence that treatment-resistant strains of Trichomonas vaginalis are growing at an alarming rate. It may happen particularly if you use the prescribed medicine irrationally.

What are your options if trichomoniasis does not respond to metronidazole?

Currently, no vaccine is available to prevent trichomoniasis. In addition, the increasing events of drug resistance have surely raised a question about the future invasion of this common parasite.

The US FDA does not approve any other oral medication to treat it. Here are some alternative options:

1) Paromomycin and furazolidone by the oral route

Regrettably, the rate of their absorption in the digestive tract is low. As a result, you may not be able to achieve an effective drug concentration in the blood.

2) Intravaginal povidone iodine solution 

A few studies have shown that nitazoxanide may be an option for patients who have not benefitted from metronidazole or tinidazole. It works against a wide range of parasites and viruses. It is available in the form of oral tablets or suspensions. Again, the problem is with its reduced absorption in the digestive tract.

Can you prevent trichomoniasis?

The only way to keep away from it is to abstain from all kinds of sexual activities. Naturally, this is not the best solution to the problem. Consider the following measures if you are sexually active:

1) Use a latex condom every time you have sex - Make sure to use the condom properly. Unfortunately, this approach does not provide complete protection. The parasite can infect other areas of the body that the condom cannot cover.

2) Cut down on the number of the sex partners - Instead of engaging sex in multiple partners, keep your sexual activities limited to only trusted partners.

Home remedies for trichomoniasis

As a matter of fact, there are no home remedies for trichomoniasis. However, you may consider some measures if they suit you. In any case, do not use them for a long time or in combination with locally applied medications.

Discontinue them when your symptoms worsen or when you develop sensitivities. Here are some home remedies you may try:

1) Tea tree oil - It may work by virtue of its antimicrobial property. Dilute it with olive or almond oil first and then apply a little amount on the vagina. If you develop an irritation, stop using it completely.

2) Bergamot essential oil - Add a few drops of this oil in your warm water bath.

3) Garlic - Taking a garlic clove or garlic supplements in pill form can help strengthen your immunity. However, if you have any chronic illnesses and taking medications for them, consult your doctor in advance. In fact, there are many known interactions between garlic and prescription medicine as well as OTC medications.

4) Yogurt - It is a natural probiotic that contains a healthy dose of beneficial bacteria. For this reason, it enhances your immune functions. Make sure to take yogurt every day.

5) Stay hydrated - Increase your water intake to activate some immune cells.

6) Eat citrus fruits - like lemon, orange, and grapefruit. They are rich in vitamin C, which is an immune booster.

7) Avoid vaginal douching - It may cause more damage to the vaginal tissues. Moreover, avoid sharing towels and other washcloths.

How do you get trichomoniasis?

  • You can get trichomoniasis if you have unprotected sex with an infected person. However, the risk still persists even if you use a condom during sexual intercourse.
  • In an infected woman, the parasite may be found in the vulva, vagina, cervix, or urethra. Likewise, males have it inside their penis.
  • When an infected person has had sex with another healthy person, the parasite can be passed to the uninfected partner. In addition, it may also infect other body parts such as the hands, mouth, or anus.
  • Whether or not you will get an infection after the exposure depends on a multitude of factors, which include age, overall health status, and of course, your immune function.

Indeed, a person with a healthy immune function is always less likely to catch an infection.

Complications of trichomoniasis

1) Increased risk of catching HIV/AIDS

The higher risk corresponds to the damage done in the vagina's protective barrier. Moreover, you may also be more susceptible to other STIs, which include gonorrhea, chlamydia, and bacterial vaginosis.

2) Pharyngitis

A 2016 study published in the SAGE Open Medical Case Reports suggests that trichomoniasis can also cause pharyngitis in some cases. However, these cases are not very serious. In fact, it responds well to oral metronidazole treatment.

3) Pelvic inflammatory disease (PID)

If you do not treat trichomoniasis in a timely manner, you may develop a more serious condition known as pelvic inflammatory disease (PID). In turn, PID may lead to infertility. Infected women may also develop fertility problems even if they do not have PID.

4) Low birth weight in newborn babies

When women become infected with trichomoniasis during pregnancy, the chances of delivering low birth weight babies and/or premature delivery are high. 

In men, an untreated trichomoniasis may result in the inflammation of the tube that carries the sperm. This condition is called as epididymitis. Additionally, some patients may develop prostatitis, which is the inflammation of the prostate gland. A few studies also link it with prostate cancer.

Key Takeaways

Treating a resistant trichomoniasis infection is a mounting challenge for clinicians. To make things worse, some patients are allergic to metronidazole or other medications of the same class.

Other highly effective medications such as povidone iodine are not available for oral consumption. Moreover, the absorption profile of nitazoxanide is weak.

Therefore, talk with your doctor about such problems, if they arise. They can suggest alternatives on the basis of their experience and availability of resources.

Finally, the situation also sheds light on the need for an effective alternative oral therapy for trichomoniasis.