Many people have often heard about the major sexually transmitted diseases, such as HIV, herpes, gonorrhea and Chlamydia, but less people are aware of the STD known as trichomoniasis. According to the Centers for Disease Control and Prevention, about 7.4 million men and women in the United States become infected with trichomoniasis each year. It is especially prevalent among young sexually active females in the U.S. It is also considered to be the most common curable STD throughout the world. 

Origins and Transmission

Trichomoniasis is an infection that often occurs in the female vagina or male urethra. Females are susceptible to contracting the disease from both infected men and women, but males usually only contract it from infected women. The source of trichomoniasis, also sometimes referred to as “trich,” is a one-celled protozoan parasite called Trichomonas vaginalis. It was first discovered and named Trichomonas vaginalis in 1836 by Donné after finding the parasite in the genital secretions of women and men. This parasite is sexually transmitted from an infected partner to another through penis-to-vagina intercourse and vulva-to-vulva (i.e., external genital area of the vagina) contact. There is literature that maintains that trichomoniasis can be contracted from genital contact with damp or moist objects such as toilet seats. However, according to the CDC, this is a “common misbelief” and is not likely to occur because the parasite cannot live long in the atmosphere or on surfaces.

Signs and Symptoms

Signs and symptoms usually occur in females within 5-28 days of exposure. Women who have trichomoniasis may experience a discharge that is yellow-green in color and frothy.  There may also be a strong odor present. In addition, women may experience tenderness, irritation and itching in their genital region. Pain may also occur during sexual intercourse and/or urination. Other symptoms that may occur are red “strawberry-like” spots on the vaginal walls and the cervix, urethritis and cystitis. It is important to note that amongst women, symptoms are not consistent and as many as 50 percent of women may not experience any signs or symptoms.

Moreover, while sometimes there are signs and symptoms that occur with trichomoniasis, the infection can be asymptomatic (i.e., no symptoms) in women and men, especially among men. Most men who suffer from trichomoniasis do not have any signs or symptoms and many of those who seek out treatment often do so because they are privy to knowing about an infected partner. Men who do experience symptoms may have urethral discharge, pain or burning during or after urination and/or ejaculation, mild itching or discharge, and irritation within the penis. According to the Merck Manual for Healthcare Professionals, the organism that causes trichomoniasis may stay in the genitourinary (GU) tract for extended periods of time, which results in the unsuspected spread to sexual partners. Five-to-fifteen percent of male urethritis in various areas may also be attributed to the parasite. It is often common for individuals who have trichomoniasis to have coinfections with other STDs such as gonorrhea.

Health Complications Associated with Untreated Trichomoniasis

There is also research that indicates that if left untreated trichomoniasis contributes to other various health complications in males and females. For women, it has been associated with infertility, herpes simplex 2 (HSV-2)  and cervical neoplasia. A study conducted by Zuo-Feng Zhang and Colin B. Begg in the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering Cancer Center in New York City concluded that “there is an association between T. vaginalis and the risk of cervical neoplasia, but that such infections account for only 2 percent of cervical neoplasia.”

Research has also shown that females with trichomoniasis have a considerably higher rate of pelvic inflammatory disease (PID) than women who are uninfected. Trichomoniasis may also cause nongonococcal urethritis (NGU) and chronic prostatitis in men. Alarmingly, trichomoniasis has also been shown to be a risk factor for HIV. A study conducted by Dr. R. Scott McClelland and colleagues demonstrated an increased risk of HIV infection among females with trichomoniasis. Dr. McClelland explains: "What this means is that a woman with trichomoniasis is at about 50 percent greater risk for acquiring HIV than a woman without trichomoniasis, after adjusting for other differences between the women such as differences in the rates of condom use, number of sex partners, etc."  Similarly, the CDC maintains that the genital inflammation that is sometimes caused by trichomoniasis can increase a woman’s vulnerability to HIV infection.

Diagnosis and Treatment

If a person experiences any signs or symptoms or suspects s/he may be infected, he or she should talk with a healthcare provider. This will assist in achieving a correct diagnosis. For trichomoniasis, a physical examination and a laboratory test must be conducted by a healthcare professional in order to diagnose the infection. For diagnoses among women, healthcare providers usually perform pelvic exams and examine the vagina and vaginal discharge. Vaginal samples are usually collected for examination. Discharge is often checked for abnormal odor and acidity. If a healthcare provider suspects a woman has trichomoniasis, s/he will conduct further tests for diagnosis. Tests vary from visual examination and detection through a microscope (i.e., wet mount test) to DNA analysis (i.e., polymerase chain reaction test). No single test is considered more supreme than the other. Diagnoses among men are usually made by gathering samples from the urethra.

Trichomoniasis is curable for both males and females. However, it is only curable through prescription drugs and not over-the-counter drugs. It is cured with the prescription drugs metronidazole or tinidazole, which are usually taken by mouth in a singular dose. An alternative treatment of metronidazole given twice a day for seven days is also sometimes used. When getting treated, both partners should be treated at the same time to cure the infection and avoid retransmission.  If one is being treated for infection, s/he should also inform any past partners of infection so that they can seek medical attention and get treatment as well. Individuals receiving treatment for trichomoniasis should avoid engaging in sexual contact with others and/or their partners until treatment is complete by all parties and no symptoms are present. It is important to note that symptoms of trichomoniasis can disappear after a few weeks in infected men who receive no treatment. Yet, infected males, who never had signs or symptoms or had their symptoms disappear, are still capable of infecting or reinfecting a partner until he has received proper medical treatment.

Prevention

Even if a person has trichomoniasis once, this does not protect him or her from contracting it again during their life time. Individuals who have been successfully treated are also still vulnerable to reinfection. There are, however, a number of ways to help prevent getting sexually transmitted diseases such as trichomoniasis. One can choose to abstain from sexual intercourse, or to be in an equally monogamous relationship with a partner who s/he knows has been tested for STDs and is known to be uninfected.

A more realistic option is to employ the use of male and female condoms and dental dams during sexual intercourse to help reduce the risk of transmission of trichomoniasis. While not 100 percent effective against STDs, when used consistently and correctly, condoms and dental dams can reduce the transmission of sexually transmitted diseases such as trichomoniasis because it acts as a barrier to secretions that are produced by the vagina and penis which carry bacteria and viruses. By learning about prevention and practicing safer sex, people can put themselves in the best position to help reduce their risk and enjoy healthier sex.