What is Trichomoniasis (Trich)?

Trichomoniasis called “trich” for short  is an STD that’s cured with antibiotics. It’s super common, and most people with trich don’t have any symptoms.

Trichomoniasis (aka trich) is the most common curable STD.

Millions of people get trich every year. It’s caused by a parasite that spreads really easily during sex. The parasite is carried in sexual fluids, like semen, pre cum, and vaginal fluids.

Most people with trichomoniasis don’t have any symptoms and feel totally fine, so they might not even know they have it. When it does cause symptoms, the most common one is vaginitis. Vaginitis is when your vulva or vagina is irritated. Trich can also infect your urethra (the tube you pee out of). Signs of trich include irritation and itching, smelly discharge, and painful or frequent peeing.

Other infections can feel like trich, so the only way to know for sure what’s going on is to see a nurse or doctor. The good news is trich is easily cured with medicine.

You can help prevent trich by using condoms every time you have sex.

How do you get trichomoniasis?

Trich is caused by a really tiny parasite called a trichomona (you can’t see it with the naked eye). People get trich from having unprotected sexual contact with someone who has the infection. It’s spread when semen (cum), pre-cum, and vaginal fluids get on or inside your penis, vulva, or vagina.

Trich is often passed during vaginal sex. It’s also spread by vulva-to-vulva contact, sharing sex toys, and touching your own or your partner’s genitals if you have infected fluids on your hand. Trich can easily infect the vulva, vagina, penis, and urethra, but it usually doesn’t infect other body parts (like the mouth or anus).

Trichomoniasis isn’t spread through casual contact, so you can’t get it from sharing food or drinks, kissing, hugging, holding hands, coughing, sneezing, or sitting on toilet seats.

Many people with trich don’t have any symptoms, but they can still spread the infection to others. So using condoms and having safer sex is the best way to prevent trichomoniasis — even if you and your partner seem totally healthy.

Symptoms in women

Trichomoniasis in women can cause any of the following symptoms:

• abnormal vaginal discharge that may be thick, thin or frothy and yellow-green in colour
• producing more discharge than normal, which may also have an unpleasant fishy smell
• soreness, inflammation (swelling) and itching around the vagina – sometimes the inner thighs also become itchy
• pain or discomfort when passing urine or having sex

Symptoms in men

Trichomoniasis in men can cause any of the following symptoms:

• pain during urination or ejaculation
• needing to urinate more frequently than usual
• thin white discharge from the penis
• soreness, swelling and redness around the head of the penis (balanitis) or foreskin (balano-posthitis)

When to seek medical advice

Visit your GP or local genitourinary medicine (GUM) clinic if you develop any of the symptoms of trichomoniasis or if you think you may be infected.

Trichomoniasis can usually be diagnosed after an examination of the genitals and a laboratory test carried out on a swab taken from the vagina or penis.

If the test shows you have trichomoniasis, it’s important that your current sexual partner and any other recent partners are also tested and treated.

How do you get trichomoniasis?

Trichomoniasis is caused by a tiny parasite called Trichomonas vaginalis.

In women, this parasite mainly infects the vagina and urethra (tube that carries urine out of the body). In men, the infection most commonly affects the urethra, but the head of the penis or prostate gland (a gland near the bladder that helps produce semen) can become infected in some cases.

The parasite is usually spread by having unprotected sex (sex without a condom). It could also be spread by sharing sex toys if you don’t wash them or cover them with a new condom before use.

You don’t have to have many sexual partners to catch trichomoniasis. Anyone who is sexually active can catch it and pass it on.

Trichomoniasis isn’t thought to be passed on through:

• oral or anal sex
• kissing or hugging
• sharing cups, plates or cutlery
• toilet seats

The best way to prevent trichomoniasis is to have safer sex. This means always using a condom when having sex, covering any sex toys you use with a condom, and washing sex toys after use.

Treating trichomoniasis

Trichomoniasis is unlikely to go away without treatment, but it can be effectively treated with antibiotics. Most men and women are treated with an antibiotic called metronidazole, which is usually taken twice a day for five to seven days.

It’s important to complete the whole course of antibiotics and avoid having sex until the infection clears up, to prevent reinfection.

Your current sexual partner and any other recent partners should also be treated.

Complications of trichomoniasis

Complications of trichomoniasis are rare, although some women with the infection may be at an increased risk of further problems.

If you’re infected with trichomoniasis while you’re pregnant, the infection may cause your baby to be either:

• born prematurely (before the 37th week of pregnancy)
• have a low birth weight

What can happen if trichomoniasis is not treated?

• Most people with trichomoniasis have no symptoms and never know they have it. Even without symptoms, it can be passed to others.
• If you have trichomoniasis, you are at higher risk of getting HIV (the virus that causes AIDS) if you are exposed to HIV.
• If you are HIV-positive, having trichomoniasis also raises your risk of passing HIV to your sex partner(s).
• The Centers for Disease Control and Prevention recommends that women with HIV get screened for trichomoniasis at least once a year.

What should I do if I have trichomoniasis?

Trichomoniasis is easy to treat. But you need to be tested and treated as soon as possible.

If you have trichomoniasis:

• See a doctor or nurse as soon as possible. Antibiotics will treat trichomoniasis.
• Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
• Tell your sex partner(s) so they can be tested and treated.
• Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get trichomoniasis again if you have sex with someone who has trichomoniasis.
• See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotics.

Does trichomoniasis affect pregnancy?

Pregnant women with trichomoniasis are at higher risk of premature birth (babies born before 37 weeks of pregnancy) or a low-birth-weight baby (less than 5 1/2 pounds). Premature birth and a low birth weight raise the risk of health and developmental problems at birth and later in life.

The antibiotic metronidazole can be used to treat trichomoniasis during any stage of pregnancy. Talk to your doctor about the benefits and risks of taking any medicine during pregnancy.

Can I take medicine to cure trichomoniasis if I am breastfeeding?

You can take the antibiotic metronidazole if you are breastfeeding. Your doctor may suggest waiting 12 to 24 hours after taking metronidazole before breastfeeding. Do not take tinidazole if you are breastfeeding.

Trichomoniasis facts

*Trichomoniasis facts Medically Edited by: Melissa Conrad Stöppler, MD

• Trichomoniasis is a sexually transmitted disease (STD) or sexually transmitted  infection (STI) caused by a parasite.
• Trichomonas infection can affect women or men and is spread via sexual contact.
• Many people who have the infection have no symptoms, but when symptoms occur, they include
  • vaginal or urethral (in men) discharge that may appear greenish and frothy;
  • burning on urination;
  • discomfort during sex, and
  • itching in the genital area.
• Diagnosis is based upon identifying the parasite through miscroscopic examination of the vaginal or urethral discharge. This is the best test for Trichomonas infection.
• Trichomonas infection can be treated and cured with antibiotic medications. Antibiotics cure the infection, but it may come back (recurr).
• If trichomoniasis is not treated the infection can persist over the long term.
• There are no effective home remedies for trichomoniasis infection.
• Trichomonas infection during pregnancy can lead to premature birth and low birth weight.

How do you get trichomoniasis?

Trichomoniasis is spread through:

• Vaginal, oral, or anal sex. Trichomoniasis can be spread even if there are no symptoms. This means you can get trichomoniasis from someone who has no signs or symptoms.
• Genital touching. A man does not need to ejaculate (come) for trichomoniasis to spread. Trichomoniasis can also be passed between women who have sex with women.

Who gets trichomoniasis?

• Trichomoniasis is more common in women than men.
• It affects more than 2 million women ages 14 to 49 in the United States.
• Trichomoniasis affects more African-American women than white and Hispanic women. The risk for African-American women goes up with age and lifetime number of sex partners.

What are the signs and symptoms of trichomoniasis?

Most infected women have no signs or symptoms. If you do get signs or symptoms, they might appear five to 28 days after exposure and can include:

• Irritation and itching in the genital area
• Thin or frothy discharge with an unusual foul odor that can be clear, white, yellowish, or greenish
• Discomfort during sex and when urinating
• Lower abdominal pain (this is rare)

If you think you may have trichomoniasis, you and your sex partner(s) need to see a doctor or nurse as soon as possible.

Is there a test to diagnose trichomoniasis?

To find out whether you have trichomoniasis, your doctor or nurse may:

• Do a pelvic exam
• Use a cotton swab to take a fluid sample from your vagina to look for the parasite under a microscope
• Do a lab test, such as a DNA test or a fluid culture. A culture tests uses urine or a swab from your vagina. The parasite then grows in a lab. It takes up to a week for the parasite to grow enough to be seen.

A Pap test is not used to detect trichomoniasis.

If you have trichomoniasis, you need to be tested for other STIs too.

What is the treatment to cure trichomoniasis?

Trichomoniasis us easily cured with one of two antibiotics:

• Metronidazole (me-truh-NYD-uh-zohl)
• Tinidazole (teye-NID-uh-zohl)

These antibiotics are usually a pill you swallow in a single dose.

If you are treated for trichomoniasis, your sex partner(s) needs to be treated too. Do not have sex until you and your sex partner(s) finish taking all of the antibiotics and have no symptoms.

What can happen if trichomoniasis is not treated?

• Most people with trichomoniasis have no symptoms and never know they have it. Even without symptoms, it can be passed to others.
• If you have trichomoniasis, you are at higher risk of getting HIV (the virus that causes AIDS) if you are exposed to HIV.
• If you are HIV-positive, having trichomoniasis also raises your risk of passing HIV to your sex partner(s).
• The Centers for Disease Control and Prevention recommends that women with HIV get screened for trichomoniasis at least once a year.

What should I do if I have trichomoniasis?

Trichomoniasis is easy to treat. But you need to be tested and treated as soon as possible.

If you have trichomoniasis:

• See a doctor or nurse as soon as possible. Antibiotics will treat trichomoniasis.
• Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
• Tell your sex partner(s) so they can be tested and treated.
• Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get trichomoniasis again if you have sex with someone who has trichomoniasis.
• See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotics.

Does trichomoniasis affect pregnancy?

Pregnant women with trichomoniasis are at higher risk of premature birth (babies born before 37 weeks of pregnancy) or a low-birth-weight baby (less than 5 1/2 pounds). Premature birth and a low birth weight raise the risk of health and developmental problems at birth and later in life.

The antibiotic metronidazole can be used to treat trichomoniasis during any stage of pregnancy. Talk to your doctor about the benefits and risks of taking any medicine during pregnancy.

Can I take medicine to cure trichomoniasis if I am breastfeeding?

You can take the antibiotic metronidazole if you are breastfeeding. Your doctor may suggest waiting 12 to 24 hours after taking metronidazole before breastfeeding. Do not take tinidazole if you are breastfeeding.

How can I prevent from getting trichomoniasis?

The best way to prevent trichomoniasis or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

Use condoms.

Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get trichomoniasis, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

Get tested.

Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

Be monogamous.

Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

Limit your number of sex partners.

Your risk of getting STIs goes up with the number of partners you have.

Do not douche.

Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

Do not abuse alcohol or drugs.

Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get trichomoniasis?

Yes. It is possible to get trichomoniasis, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of trichomoniasis.

Diagnosis

A significant number of women infected with trichomoniasis have no noticeable symptoms. If symptoms develop, they usually occur within five to 28 days after exposure to an infected partner. However, in some cases, the symptoms may be delayed for longer. The most common symptoms are vaginal discharge, irritation, itching and burning during urination.

Trichomoniasis most often presents as a yellowish-green vaginal discharge with a strong odor. Itching and soreness of the vagina and vulva are common. Some women experience vague abdominal pain. Trichomoniasis can occur with other infections, particularly pelvic inflammatory disease and bacterial vaginosis.

The majority of men infected with Trichomonas do not have symptoms. The most common symptom is discharge from the penis or burning with urination. When men have symptoms, they often subside without treatment after a week or more.

For both men and women, a diagnosis based on symptoms is inadequate because many of these symptoms are shared with other inflammatory conditions of the vagina and cervix, such as bacterial vaginosis and yeast infections.

For women, the most common way to diagnose trichomoniasis is by physical examination of the pelvic area by a health care professional and by looking at a sample of vaginal fluid under a microscope (called “wet mounts”) for the presence of protozoa. A pelvic examination can reveal small red ulcerations on the vaginal wall or cervix. The wet mount technique, however, is accurate only about 60 percent to 70 percent of the time, as protozoa may be hard to find or mistaken for normal cells. It can also yield false positives. There also are several rapid-diagnostic kits available that can diagnose infection in 10 to 45 minutes. These tests also come with the risk of false positives.

More reliable tests have been developed, such as the polymerase chain reaction (PCR) test, a type of nucleic acid test that uses enzymes to better detect the virus in the culture. It is very effective in identifying T. vaginalis in women and is becoming more readily available.

Treatment

The standard drugs used for treating trichomoniasis are metronidazole (Flagyl) and tinidazole (Tindamax). In most cases, Trichomonas infection is cured in women with a single oral dose of two grams of either drug. Both of these prescription drugs are in the nitroimidazole class. Metronidazole has been found to be safe in pregnancy.

Prevention

Prevention of trichomoniasis is similar to that for other sexually transmitted diseases (STDs). Protective measures include:

 Facts to Know

1. Trichomoniasis is the most common curable sexually transmitted disease in the United States. According to the CDC, about 3.7 million people in the United States have trichomoniasis.
2. Trichomoniasis is more common among African American women. The reason for this is not clear. Lack of access to medical care in economically challenged communities may play a role.
3. Trichomoniasis increases a woman’s risk of preterm birth or delivery of a low birth weight baby.
4. It is important that sexual partners of infected women be treated. Although trichomoniasis is often asymptomatic in males, if left untreated it can cause urethral infections, particularly urethritis, and can lead to reinfection of the woman.
5. Because a test for vaginal infection is not necessarily a part of a routine pelvic exam, you can’t assume your health care professional will test you for trichomoniasis. You should request trichomoniasis screening if you have symptoms or if you have been in contact with a high-risk sexual partner.
6. You can have more than one type of vaginitis at the same time. It is possible to have trichomoniasis and bacterial vaginosis together, each of which can be treated with metronidazole.
7. If you visit your health care professional to see if you have a vaginal infection, you should schedule your examination when you are not having your period.
8. It is easy to misdiagnose trichomoniasis or bacterial vaginosis as a yeast infection because yeast infection also causes an unpleasant discharge. Treatment for yeast infections is different than for trichomoniasis or BV, so an accurate diagnosis is important.

Key Q&A

1. How do I know if I need to see my health care professional?Pay attention to your body. Call your health care professional if you experience any unusual symptoms, such as: a change in the color, odor or consistency of vaginal fluid; vulvar irritation; itching; and burning, frequent or painful urination.
2. What if I am allergic to the 5-nitroimidazole drugs (metronidazole or tinidazole) or am not responding well to them?Up to 10 percent of women do not respond to standard treatment. For those who fail treatment, a longer course of metronidazole is recommended by the Centers for Disease Control and Prevention (CDC). If this second course of medication fails, the CDC recommends two grams daily for five days of either metronidazole or tinidazole.If you develop a rash in response to the 5-nitroimidazole drugs, there are other medications you can try, but they have poor cure rates. If you are allergic to tinidazole and metronidazole, your provider may suggest desensitizing you to these medications so you can undergo treatment.
3. What are my chances of having trichomoniasis reoccur?Treatment is successful in most women, and once the organisms are killed they don’t come back unless you are exposed again to an infected partner.
4. What is the relationship between vaginitis and excessive douching?The healthy vaginal ecosystem requires just the right balance of bacteria flora. These bacteria make natural acids that keep abnormal bacteria from becoming predominant. Douching may disrupt the pH balance of the vagina and lead to bacterial vaginosis, which may increase a woman’s risk of acquiring trichomoniasis.
5. What about diagnosing and treating trichomoniasis in men?The organisms that cause trichomoniasis often don’t cause symptoms in males. Consequently, most men never seek treatment because they don’t know they are infected. Diagnosis in men is usually made with a urine culture specifically for Trichomonas. If your sexual partners are not treated, it is likely you will become reinfected.
6. What is considered normal vaginal discharge?For uninfected women, vaginal discharge is usually cloudy white in appearance. Discharge often increases in the middle of your menstrual cycle, and during ovulation it changes consistency, appearing similar to egg whites. Symptomatic women with trichomoniasis experience a frothy, yellow-green vaginal discharge with a strong odor, possibly coupled with discomfort during intercourse, painful urination or genital itching.

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