This article focuses on Trichomoniasis and it is meant to provide useful information, to educate, and give answers to some questions that you might have about this disease.

What is Trichomoniasis?

Trichomoniasis is a parasitic infection that occurs in the genital area (vagina, cervix, penis, and urethra) of both men and women. It is a very common sexually transmitted disease. Statistics show that women are more likely to get infected than men.

Often the infection causes no symptoms – only about a third of those who are infected experience itchiness, burning sensation, or irritation. The parasite, Trichomonas vaginalis, which causes the condition, responds well to medical treatment. In most cases vaginalTrichomoniasis is successfully treated over the course of just a few days. However, the probability of getting infected again is high.

Signs and Symptoms

Around seventy percent of people who contract Trichomoniasis do not experience any symptoms. This is the reason the disease is often left untreated for long periods of time, which also enables it to be transmitted to a larger number of people. When symptoms do occur they usually manifest as itchiness and irritation in the genital area and a feeling of discomfort while urinating.

The most common symptoms for women include:

• Inflammation of the genitals (soreness, redness, etc.) followed by the feeling of itchiness.
• Increased vaginal discharge followed by an unpleasant smell (fishy smell). The discharge can be white, greenish, yellow or colorless.
• Discomfort or burning while urinating.

The first symptomatic manifestation of Trichomoniasis in women is inflammatory vaginitis. When examined, the cervix may appear slightly changed in size, shape, and color, being named the strawberry cervix. These changes should be checked with a follow-up Pap smear after the successful treatment of Trichomoniasis.

The vaginal pH levels increase as well and the infections of the Skene and Bartholin gland are not rare.

In men, the usual symptoms of Trichomoniasis are:

• Irritation and itching of the penis
• A burning sensation after ejaculation and urination
• Discharge from the penis

Rarely, Trichomoniasis can cause severe inflammation and pain in the lower abdomen. The symptoms usually start to manifest between 5 and 28 days after the infection. Although it is not rare for them to appear much later. Infected women are more likely than men to experience the symptoms of this condition. If left untreated, the infection can last for a very long time, ranging from several months to years. Untreated Trichomoniasis can be a cause of preterm birth and infertility.

It is not completely understood why some people do not develop any symptoms, but it is believed that this could be connected with the overall health of the infected person. In some cases, symptoms can come and go away in a repetitive manner, without any treatment. Having Trichomoniasis makes those who are infected more likely to contract and transmit other STDs, including HIV.

Recommended Read: Pathology and Transmission of HIV

Diagnosing Trichomoniasis

If you are experiencing any of the symptoms mentioned above or, for any reason, you suspect that you might be infected with Trichomoniasis (e.g. one of your partners has it), you should seek help from a medical professional.

Several very simple and reliable methods for diagnosing Trichomoniasis are available. These methods do not differ much from other diagnostic methods for diagnosing infections in the urinary and genital tracts. The most common ones are:

• Microscopic examination of samples obtained with a vaginal or penile swab. The identification of the presence of one or more trichomonads in the sample makes up a positive result. The microscopic examination is certainly the simplest and most cost-effective way of diagnosing Trichomoniasis but, due to the possibility of a low-quality specimen being examined, the sensitivity of this method is low (between 60 – 70%).
• Culture is probably the most common method used for diagnosing Trichomoniasis. Solid sensitivity (70 – 89%) and reasonable cost make this diagnostic method both reliable and affordable. The downside to it is the time it takes to have the results (up to seven days).
• NAAT’s, or Nucleic Acid Amplification Tests are considered to be highly sensitive (80 – 90%). This form of molecular testing is very reliable and more costly compared to other diagnostic methods. The usual sampling method for men is the, so called, first-catch urine sample, while a vaginal swab specimen is obtained for women.

The specimens obtained for testing on Trichomoniasis are usually used to test for other sexually transmitted diseases as well, such as syphilis, gonorrhea, and HIV.

Prevention

The only sure way to prevent the Trichomoniasis infection is the abstinence from any kind of sexual activity, including vaginal, oral, and anal sex. Since this is not a likely option for the majority of sexually active people, there are other methods of prevention, but none of them are 100% safe. However, lowering the risk of infection is possible and there are several ways to do so:

• Staying in a monogamous relationship is a good way to prevent Trichomoniasis. Since Trichomoniasis is very common, changing sexual partners carries a big risk in contracting the infection. If you and your partner have both been tested and the results are negative, the risk of contracting Trichomoniasis in a way not involving the sexual intercourse with other people is almost non-existent.
• The use of male or female condoms is desirable as it provides a certain level of protection. However, even the proper use of condoms does not guarantee that the infection will not occur. This is because certain genital areas are not completely covered by condoms.
  Trichomoniasis is almost exclusively sexually transmitted. Other ways of transmitting this infection (through water, urine, etc.) have not been recorded or proven.

Treatment

Treatment for Trichomoniasis is rather simple and highly efficient (95 – 97%). It usually involves taking antibiotics by mouth. The most common medications used are the metronidazole and tinidazole. One dose of the medication is usually enough. In certain cases, such as with women living with HIV, a seven days therapy with medications is preferable. Some topical treatments for Trichomoniasis are also available but are considered far less effective. To avoid the possibility of suffering abdominal pain, nausea, and vomiting, drinking alcohol is not recommended during the course of the therapy as well as 48 hours after the last dose of the medication.

In men, Trichomoniasis can sometimes (not often) resolve on its own. Women usually require medical treatment. Whatever the case is, if one of the sexual partners is diagnosed with Trichomoniasis, the other one should be medicated too, without the need for testing. The same goes for all the other sexual partners of the infected individual in the sixty days prior to the diagnosis.

There is a small percentage (less than 5%) of Trichomoniasis resistant to medication treatment. Once the treatment has been completed, it takes about a week for the body to be completely cleared from the infection. During this time the sexual intercourse of any kind (oral, vaginal, or anal) should be avoided, to lower the risk of re-infection. The re-infection can also occur if the treatment with antibiotics has not been properly administered or completed. Statistics show that one in five of treated individuals get re-infected in the three months following the treatment.

Possible Complications

Although it is a successfully treated disease, the nature of Trichomoniasis and its lack of visible symptoms can sometimes make it an underlying cause for more serious health issues. Medical science still lacks the in-depth knowledge about how the Trichomoniasis infection can affect other processes in the human body.

One clear connection between a long-term, untreated Trichomoniasis infection and pregnancy has been established. Pregnant women suffering from Trichomoniasis are more likely to experience a pre-term delivery (1.4 times more likely) and give birth to children with low birth weight (less than 5.5 pounds). Other complications, such as pre-labor rupture of membranes and respiratory problems affecting infants are also possible but less common.

A long-time Trichomoniasis infection, when untreated, increases the risk of transmitting and acquiring HIV. In men, the undetected infection can leave long-term consequences, such as chronic prostatitis which can be a contributing factor to the later development of prostate cancer.
Serious inflammation of the pelvic area is possible in both men and women suffering from a severe case of Trichomoniasis. Lower sperm count has also been recorded in men leading to infertility.

The Final Word

Trichomoniasis is a disease that affects sexually active individuals of both genders. It is a successfully and rapidly cured condition if the treatment is proper and comprehensive. Without the treatment, the infection can be asymptomatic, very persistent, and cause various, mild to severe, consequences. The risk of re-infection is high, especially with the change of the sexual partner. The follow-up examination, three months after a successfully completed treatment, is highly recommended.

Pregnant women should take special care and get tested for Trichomoniasis. The tests should always include other sexually transmitted diseases. Outcomes for Trichomoniasis treatment are, in a great majority of cases, very positive and a complete recovery is usually achieved.