What is Trichomoniasis?
Trichomonas vaginalis, commonly known as trich, is one of the most typical cases of microorganism infection in the United States and often leads to vaginal inflammation in women. This active microorganism thrives in the lower urinary and reproductive system of women, and in the prostate and urethra of men. It’s worth mentioning that men who carry this microorganism often don’t show any symptoms. When comparing with other non-viral sexually transmitted infections (STIs), Trichomonas vaginalis is the most widespread in the United States. One worrisome fact is that trich increases the chances of transferring the HIV virus in both women and men. Moreover, this infection could also lead to negative effects during pregnancy. Unfortunately, this disorder often goes undetected, and many patients try to treat it themselves. In many instances, doctors often do not test the sexual partner, further facilitating the continuous spread of this infection. Currently, the go-to medication is an oral drug called metronidazole, but if this doesn’t work, other medications belonging to the same group, nitroimidazoles, may be used as an alternative treatment.
What Causes Trichomoniasis?
Trichomoniasis is an infection that you can get through sexual contact. It’s able to survive for a few hours in moist environments, but almost all cases are caught through sexual transmission. This means you can get it from someone who already has the infection.
There are certain things that can make you more likely to get trichomoniasis, including:
- Having had a sexually transmitted infection (STI) in the past
- Having a new sexual partner or having many partners
- Having sexual contact with someone who has the infection
- Using intravenous (IV) drugs, which means drugs that are injected into your veins
- Not using any kind of barrier contraceptive, like condoms or dental dams
Risk Factors and Frequency for Trichomoniasis
Trichomoniasis is an infection that occurs more often in individuals who have multiple sexual partners and other sexually transmitted diseases. In a specific study with over 4,000 people, this infection was detected in 0.5% of males and 1.8% of females. The same study also noted that this infection was more prevalent in Black participants – 4.2% in males and 8.9% in females.
An article estimates that 3.2% of the population has Trichomoniasis. This infection’s rate is higher in the United States when compared with two other sexually transmitted infections – Neisseria gonorrhoeae and Chlamydia trachomatis, even when combined. Trichomoniasis is most commonly seen in women between 40 to 49, which is very different from Chlamydia which is most common in young adults between 19 to 24.
Signs and Symptoms of Trichomoniasis
Trichomoniasis is a sexually transmitted infection (STI) that can present differently in women and men. Women often experience symptoms like vaginal discharge, painful intercourse, symptoms similar to a urinary tract infection, vaginal itching, and pelvic pain. On the other hand, men might not have any noticeable symptoms. Sometimes, men may have symptoms like penile discharge, testicular pain, painful urination, frequent urination, or cloudy urine. Trichomoniasis can lead to inflammation of the urethra in men, and in rare cases, inflammation of the epididymis or prostate.
Important questions to ask for diagnosis could revolve around past STI treatments, usage of condoms during sexual intercourse, and the presence of an unpleasant-smelling discharge.
During a physical check-up, women often have a pelvic exam while men may have a urethral swab.
Common physical findings in women include a thin, frothy vaginal discharge with an unusual smell, redness and swelling of the genitals, and a “strawberry cervix”, which is observed in about 40% of patients. Mild tenderness may also be felt during a pelvic exam.
Testing for Trichomoniasis
The most usual test done when trying to diagnose Trichomonas vaginalis — a common sexually transmitted disease — is wet prep microscopy. This is where doctors look at a sample under a microscope for the signs of the infection. They know what to look for because the organisms causing this condition have thin, whip-like appendages and can be seen moving under the microscope. This method is chosen often because it’s easy to do and doesn’t cost much. However, it only correctly identifies the infection in 40% to 60% of the cases.
A new type of test called the Nucleic Acid Amplification Test (NAAT) is becoming more common in detecting the Trichomonas vaginalis infection. This test is already considered the best choice for diagnosing other sexually transmitted diseases like gonorrhea and chlamydia. NAATs have shown to be more than 90% accurate in both detecting the presence of the disease (sensitivity) and confirming the absence of the disease (specificity) when testing for Trichomonas vaginalis.
Before NAATs and similar tests were developed, the best way to test for Trichomonas vaginalis — if the patient was showing symptoms but the wet prep test came out negative — was through a culture test. Culture tests involve growing the organism in the lab to confirm its presence.
Another simpler test involves checking the acidity level (pH level) of vaginal hygiene. If the pH is more than 4.5, it may suggest the presence of Trichomonas vaginalis. However, this is not a specific indicator as other conditions can also cause a higher pH.
Finally, the whiff test can also be done. In this test, a few drops of a chemical called potassium hydroxide are added to a sample of vaginal discharge. If the result gives off a fishy smell, it could indicate trichomoniasis. However, like the pH test, the whiff test alone cannot definitively confirm a diagnosis of Trichomonas vaginalis. These are all tools your healthcare provider may use to ensure an accurate diagnosis.
Treatment Options for Trichomoniasis
According to the most recent health guidelines from the CDC in 2021, the prescribed treatment for sexually transmitted infection (STI) like trichomoniasis always includes the use of metronidazole. Typically, the medication is given twice a day for a week. This recommendation also applies to patients who have HIV.
An interesting study found that women show a better response to seven days of treatment with metronidazole as opposed to a single-dose treatment. According to the data, 11% of women who took the seven-day treatment were still positive for trichomoniasis on their test after the treatment compared to the 19% who remained positive following the single-dose treatment.
If trichomoniasis is not treated, it may remain silent or eventually be overcome by the patient’s immune system. It’s important to note that in pregnant women, trichomoniasis must be treated as leaving it untreated can have adverse effects on both the mother and the baby. Metronidazole is the preferred drug for this treatment, however, breastfeeding should be stopped during this treatment period.
The CDC advises performing a follow-up test (a test of cure) for all women treated for trichomoniasis within three months of treatment. This test, called Nucleic acid amplification testing (NAAT), can be done as soon as two weeks after the treatment and is more sensitive and hence recommended.
In many states, the law allows for expedited partner therapy (EPT), where a sexual partner can be treated without needing a medical examination or starting a patient-doctor relationship. The CDC lists the states and the exact laws surrounding EPT on their website.
Treating for other STDs such as chlamydia and gonorrhea when a patient already has trichomonas is a decision that should be made between the doctor and patient, and is not always recommended by the CDC. Several factors, such as the patient’s ability to follow up on treatments and the risks and benefits of treatment must be considered.
In cases where metronidazole is not effective, another medication tinidazole can be used. When on these drugs, patients should avoid alcohol. There are topical treatments available, but these have not shown to be effective and are not recommended.
What else can Trichomoniasis be?
When a patient shows signs of trichomoniasis, which is a sexually transmitted infection (STI), the health care provider should also consider the possibility of other STIs. This is because sometimes multiple STIs can occur at the same time. For example, when a female patient shows symptoms and is worried about having an STI, the health care provider should also consider the possibility of pelvic inflammatory disease (PID). PID is a serious condition that can reduce a woman’s fertility.
It’s important to note that trichomonas, the parasite that causes trichomoniasis, doesn’t cause PID. So, if PID is suspected, the treatment plan will be different.
What to expect with Trichomoniasis
People treated with a medication called metronidazole typically have a 90% to 95% chance of being cured. Interestingly, the chances of being completely cured are even higher when the patient’s partner is also treated. Recurring infections, however, are quite common among sexually active people.
Trichomoniasis, the condition being treated here, is closely linked with the presence of other sexually transmitted infections (STIs) such as HIV, gonorrhea, HPV, herpes, and chlamydia. Women who are pregnant and have this condition face potential risks like early delivery, giving birth to babies with low weight, and premature rupture of the membranes that hold the baby in the womb.
Additionally, there is a significant risk of developing pelvic inflammatory disease, a condition that can cause issues with fertility and long-term pelvic pain.
Possible Complications When Diagnosed with Trichomoniasis
Trichomoniasis is a condition that can cause serious health problems if left untreated during pregnancy. These problems include premature birth, babies with low birth weight, and early breaking of the mother’s water bag.
Studies have shown that having trichomoniasis increases the risk of getting HIV and other sexually transmitted infections. In men, this disease could lead to inflammation in the epididymis or prostate, and potentially infertility.
- Potential problems during pregnancy due to untreated trichomoniasis
- Premature birth
- Babies with low birth weight
- Early breaking of water bag
- Increased risk of getting HIV and other sexually transmitted infections
- In men, potential inflammation in the epididymis or prostate
- Potential infertility in men
Preventing Trichomoniasis
When a doctor prescribes medications like metronidazole or tinidazole, they’ll advise patients not to drink alcohol. This is because these antibiotics can cause reactions similar to those experienced by people taking medication to stop drinking (like Disulfiram) if alcohol is consumed at the same time. After taking metronidazole, patients should avoid drinking alcohol for a full day. After tinidazole, the alcohol-free period should last for three days.
If a doctor diagnoses a patient with a sexually transmitted infection called trichomoniasis, they will educate the patient about safer sexual practices. The patient will also be asked to tell their sexual partners about this diagnosis so they can seek treatment as well. It’s important to avoid sexual intercourse until both the patient and their partner(s) have been successfully treated and no longer have any symptoms. This helps to prevent the infection from being passed back and forth.