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Trichomonas vaginalis infection – Trichomoniasis

Trichomoniasis is one of the most common sexually transmitted infections (STI) worldwide. The cause is the parasite Trichomonas vaginalis.

This parasite is responsible for infecting the sex organs (genitalia) and the urinary system that stores and discharges urine.

Most of the patients with this infection remain without symptoms. Still, they can also present symptoms such as vaginal discharge and vulvar irritation in females, and either male or female, genital itching, and pain while urinating.

It is a public health problem that affects everyone and is growing day by day. The most important element is that the infection, in most cases, can be cured quickly and effectively with the right treatment. 

Importantly, people with trichomoniasis are likely to contract other (STI) such as human immunodeficiency virus (HIV), gonorrhea, human papillomavirus (HPV), herpes simplex virus (HSV). So, it represents a further risk for patients.

This infection affects around eight million people per year in the United States, positioning itself as one of the most common sexually transmitted diseases. However, it isn’t easy to obtain an exact figure since most of them are usually without symptoms or asymptomatic. Therefore, they tend to remain undiagnosed.

The World Health Organization estimates that there are more than two hundred twenty million cases per year globally, with a higher number in females than males. Notably, most of those cases occur in people over 25 years of age, although the younger are not safe at all.

By reading this article, you will learn leading information about Trichomoniasis, including its causes, symptoms, complications, and treatment. Please, continue reading to get pearls on this topic directly from a doctor. 

What is trichomonas vaginalis, and how does it infect?

Trichomonas vaginalis (T. vaginalis) is a small parasite of the protozoan family similar in size to a white blood cell, which is very tiny. One of its main characteristics is a mobile whip-shaped appendix that allows it to move easily throughout surfaces.

Due to its excellent mobility, it can move through vaginal fluid in women or semen in men at the time of sexual activity, specifically between women and men. It occurs during vaginal sex without protection. Currently, there are no cases of trichomoniasis because of anal sex, although researchers have found it in that body area.

Once it enters the urogenital system of the person, it reaches and stays in any of these structures: vagina, cervix, urethra, and bladder in women or urethra, external genitalia, prostate, and semen in men.

Once it gets to any of these body places, it starts replicating, and the incubation time, which is the period it takes for it to produce symptoms, ranges between four to twenty-eight days to manifest them. The latter period is mostly true for male patients; for females, it could take even more. Also, patients could stay without symptoms.

It does not matter if you have or do not have symptoms. From this moment on, the person with trichomoniasis can infect a partner through sexual contact even without knowing it.

What is the cause of trichomoniasis?

The leading cause is having sex without protection.

The people most likely to get the infection are:

  • People with multiple sexual partners.
  • People who exchange sex for drugs or money.
  • Having sex with an infected person.

People with the previous infection of any sexually transmitted disease such: as Chlamydia, genital herpes, HIV infection, gonorrhea, HPV, and Syphilis. They mean an additional risk factor for developing trichomoniasis; often, they could co-exist together.

How do you know if you have trichomoniasis?

It is difficult to know if you have trichomoniasis because more than fifty percent of females and eighty percent of males are without symptoms. Also, this situation could exist for several years.

Notably, thirty-three percent of women without symptoms can develop them within six months. Therefore, the only way to know if you have vaginal trichomoniasis infection is through the appearance of symptoms that we will see in the following fragment and ultimately by getting tested afterward.

Also, if you do not have symptoms but you have several risk factors for it. You can know if you have the infection by screening with special tests. Please keep reading for learning about this disease.

What are the symptoms of trichomoniasis in females?

A vast proportion of patients is without symptoms but in case of presenting them. They report having:

  • Abnormal vaginal secretions with an unusual color and a musty-like odor
  • Itching, burning, or ache in the genital area
  • Pain during sexual intercourse
  • Pain while urinating
  • Bleeding after sexual intercourse

Abnormal discharge can also relate to other inflammatory pathologies. Such as cervicitis, which corresponds to the inflammation in the lower and narrow part of the uterus (cervix). This situation could also exist in trichomoniasis. A doctor would think about this entity if it sees discharge coming out from the cervix.

The other one is the inflammation of the vagina (vaginitis). Trichomoniasis is one of the three more important causes of vaginal infection; it produces itching and pain that may be even present in complicated trichomonas infection.

How does trichomoniasis discharge look?

Trichomoniasis discharge looks like an abnormal vaginal discharge that can be thick, sticky yellowish, whitish, green liquid with bubbles or blood tinges with a musty-smell.

What are the clinical features of trichomoniasis?

The principal clinical of trichomoniasis infection is unusual vaginal discharge, usually yellowish or greenish, sticky, and foamy with an unpleasant odor. 

When performing a gynecological examination, it may be present in the lower part of the uterus extending to the vagina (cervix) a redness with irregular edges called colpitis macularis or strawberry cervix, which is very specific and suggestive of trichomoniasis.

This gynecological procedure allows doctors to do a precise assessment of the cervix, vagina, and vulva. Vaginal discharge and colpitis macularis are great for determining the diagnosis of trichomonas infection.

During vaginal infection, a pH imbalance can occur, causing an increase in pH (> 4.5), with normal values ​​between 3.8-4.5, and some tests detect such imbalance. Notably, a vagina with a normal pH virtually discards having this infection. Still, a pH greater than 4.5 (a positive test) does not confirm trichomoniasis because other diseases could result positively too.

Some patients could manifest having pain in the lower abdomen below the belly button, but it is rare. It can also exist together with yeast infections such as candidiasis, bacteria like Neisseria gonorrhoeae, and bacterial vaginosis, resulting in a clinical mix of these infections.

How long can an infected person spread trichomoniasis?

It is difficult to determine how long a person with trichomoniasis can transmit the disease. This situation mostly exists because it is unknown when someone has trichomoniasis in the vast majority of the cases. Remember that symptoms, if they appear, arise between four and twenty-eight days after incubation.

People that remain without symptoms, which are a wide proportion. They have the parasite for years, being able to infect their partners during unprotected sex.

In the case of being a person with symptoms, receiving pharmacological treatment is a must. Both the infected person and their sexual partner should begin treatment for trichomoniasis, including pregnant women, through antibiotics administration. Most of the time is metronidazole.

Besides, both the patient and the sexual partner should abstain from having sexual intercourse until the drug treatment is complete. For the symptoms to disappear, it takes approximately one week. Once the treatment is finished, they should be free of disease and not infect other people through sexual contact. However, most doctors perform exams to confirm that the parasite eradication was successful.

Cases of reinfection are frequent; therefore, some people who take the treatment may get trichomoniasis again. Approximately, one in five sexually active females is re-infected within three months of treatment.

The Centers for Disease Control and Prevention (CDC) recommend a check-up at three months after the treatment depending on the situation to ensure that it was successful or in case symptoms return.

Does trichomoniasis mean your partner cheated?

Not really. Although Trichomoniasis is a sexually transmitted disease, this doesn’t mean your partner is a cheater for having it. Remember, trichomoniasis does not show symptoms in most of its cases. So, if your partner starts having trichomoniasis symptoms, there’s a chance that they got it a long time ago.

The other possibility is that you are the person who suffers from trichomoniasis without symptoms. So, you are the one who passes the infection to your partner.

But this does not rule out that you or your partner may have been with someone else who had trichomoniasis and became infected without knowing it.

What are the complications of it?

Trichomoniasis increases the risk of having later in life another sexually transmitted infection such as HIV infection, gonorrhea, viruses like human papillomavirus (HPV), herpes simplex virus (HSV). Then, all of them could represent severe complications in the long run.

Complications in women.

Another common complication in women is a pelvic inflammatory disease, which is a severe infection. The pain occurs in the lower abdomen due to swelling and infection in women’s reproductive organs: the uterus, the fallopian tubes, and adjacent pelvic structures.

Other complications include vaginitis, cervicitis, and swelling of the female genital structure’s attachments, such as the lining covering the internal part of the uterus (endometrium) and the glands located around the vagina (Skene and Bartholin glands) concerning female ejaculation.

The T.vaginalis can similarly affect the ovaries and fallopian tubes, producing a Tubo-ovarian abscess in rare cases. Sadly, trichomoniasis can cause women to become infertile, which translates into difficulties getting pregnant.

This infection links to developing pre-cancerous lesions within the uterus, which stands for Cervical intraepithelial neoplasia. Moreover, women that underwent hysterectomy (took out their uterus) and had trichomoniasis. They are prone to more complications after this surgery, such as swelling and infections.

Trichomoniasis could also prompt complications in pregnant women.

Several complications can exist in pregnant women because of trichomoniasis. It includes babies born with lower weight than they should have, women giving birth before thirty-seven weeks of pregnancy (a normal pregnancy lasts between 37 to 42 weeks), and passing the infection to their baby.

One of the reasons for early delivery is premature rupture of the membrane. The latter is due to the body’s defense mechanism to respond to the infection, which causes the baby to be born before the expected time (premature) and have low birth weight.

The mother with trichomoniasis can transmit the child’s infection during the birth canal, producing a genitourinary infection or lower respiratory tract infection.

Complications in men.

In men, the vast majority are without symptoms, and their resolution is usually faster than women. In case of symptoms, they may present itching and urethral discharge of pus.

Among the complications men patients could have; there are infection and swelling of deeper genital and urinal structures, and the worst of them, infertility.

One of the structures that could be affected includes the prostate, which receives the name of prostatitis. Then, the epididymis is a special structure alongside each testicle that allows storage and transporting sperm. When it swells, which could also occur in trichomoniasis, its name is epididymitis.

Another important complication is urethral stricture disease. The tube that allows urine to flow from the bladder to the tip of the penis, in this situation, narrows. Therefore, men could trouble when urinating because the space urine has for getting out is now smaller.

Infertility in men because of trichomoniasis exists due to poorer sperm quality in those patients. The sperm normal capacity of moving and resistance decreases in these circumstances.

How is trichomoniasis diagnosed?

Tests that detect the parasite directly.

Trichomoniasis requires laboratory tests to diagnose the disease since several of its symptoms are not specific enough.

Currently, the best tool doctors have to confirm trichomoniasis in a person is the molecular diagnostic test. It detects the vaginal trichomonas parasite. All these test sources on the vaginal fluid as a sample for women and urine or urethral swabs for men.

The Food and Drug Administration (FDA) handles six molecular tests to diagnose trichomoniasis infection: Affirm VPIII Microbial Identification Test, APTIMA T vaginalis assay, BD ProbeTec TV Qx Amplified DNA Assay, OSOM Trichomonas Rapid Test, Solana Trichomonas Assay, and Xpert TV Assay.

Only Affirm VPIII has a relatively low capacity to detect trichomoniasis infection in women. The remaining tests have both a great ability to detect and rule out the infection. According to the FDA, in men, the only molecular test available for diagnosis is Xpert TV, although APTIMA may also be used.

Formerly, there was a test that, although not always yielding positive for the patients when infected; it is very cheap and easy to carry out. That is the wet saline mount evaluation. Nowadays, given its simpleness, doctors still use it. However, this test tends to be positive only in women with high amounts of the parasite, and it is not available for men.

Before the era of molecular tests, the test that surpassed the wet saline mount evaluation’s effectiveness was a standard culture. It remains useful in cases where molecular tests are not available; besides, it is beneficial for patients with difficult to treat trichomoniasis, and it is available for men.

Tests that do not directly detect the parasite but are useful in other ways.

  • Pap smear: This test has a low capacity to detect trichomoniasis in people. It is mostly used to detect cervical cancer. However, it is possible to see the parasite in this test if we are lucky enough.
  • Smell test: In a vaginal discharge sample, a few drops of 10% potassium hydroxide are placed. If It smells like fish, we can diagnose bacterial vaginosis or trichomoniasis (it is positive for both of them).
  • PH test: Please bear in mind that in trichomoniasis, the vaginal pH usually increases. Doctors take samples of the pH from body fluids, like vaginal secretions, through a swab. If the pH is within normal ranges, doctors discard trichomoniasis. Still, if it is more than 4.5, it can be trichomoniasis. However, this test is not specific for trichomoniasis because other diseases can increase the pH.

What is the treatment for trichomoniasis?

Like other infections, the treatment for trichomoniasis requires an antibiotic. Also, doctors need to monitor patients and keep track of them. Remember that despite treatment is successful most of the time. Patients could have the infection again, or maybe their parasite is resistant to the given treatment.

Antibiotic treatment consists of the first choice of administering Metronidazole single dose of 2g or Tinidazole, also a single dose of 2g. Patients should avoid drinking alcohol till 24 and 72 hours after using metronidazole and tinidazole, respectively.

Another option is using Metronidazole of 500 mg every 12 hours for seven days. Likewise, pregnant women can take metronidazole as treatment, preferably with the single-dose type of treatment.

It is necessary to know that both the infected person and its sexual partner require treatment. They must also abstain from having sexual intercourse while taking the treatment until they do not present any symptoms.

So, it is important to carry out a control test three months after completing the treatment due to the high reinfection rate, especially in sexually active women.

Nowadays, it is not a recommendation anymore to treat trichomoniasis only with topical therapy. This treatment comprises the same antibiotics, but in creams or ovules, women put into their vagina. The formal recommendation is to treat this infection with oral pills. Also, in sporadic and severe cases, there is the possibility of receiving treatment directly through a vein.

How can trichomoniasis be prevented?

The best way to prevent trichomoniasis is by using protection during sexual intercourse, such as condoms, for example, latex condoms, among other mechanical contraceptives to avoid sexually transmitted diseases.

Furthermore, if someone reduces the number of different sexual partners it has, it reduces the chances of getting STIs or trichomoniasis. In light of this, having a monogamous relationship would suit best for this purpose. Keep in mind that before engaging in any new sexual relationship, screening for STIs would be ideal.

Take care of yourself and your partner.

Do you have symptoms of this infection?

This tool is a Trichomoniasis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this infection. Therefore, the tool aims to identify the symptoms that are because of trichomoniasis. Besides, it could be positive if somebody has too many risk factors for the infection. It is free and would take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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