Trichomoniasis: Symptoms & Treatment

Trichomonas is a common sexually transmitted disease caused by a single-cell parasitic protozoan Trichomonas vaginalis, which was first discovered in 1836. It is more prominent in women but can appear in men as well.

Trichomonas vaginalis

Trichomonas vaginalis is a very common parasite. They are usually pyriform in shape, although they may take an amoeboid shape after attaching to the vaginal epithelium. The size can vary but most commonly the individual organism is slightly larger than a white blood cell, which means about 9X7 μm. Four flagella-whip-like parts project from the anterior portion of the cell. Generally, it infects the squamous epithelium of the genital tract. Incubation time is usually between 4 and 28 days.

Transmission

Trichomoniasis is primarily a sexually transmitted disease, and it can be spread during:

• anal sex
• mutual masturbation when bodily fluids from one partner come in contact with the other's genitals
• oral sex
• vaginal sex

 
Since Trichomonas can survive for some hours outside the body it can also be can be transmitted by sharing:

• bodily fluids
• contaminated bedding
• damp towels
• sheets
• toilet seats

Incidence of the condition

Trichomoniasis is the most common non-viral sexually transmitted disease in the world. About 5 million Americans develop trichomoniasis every year. It has been found in 5%-15% of women at gynecology clinics and 50%-75% of prostitutes in the United States. Trichomoniasis is present in the sexually active population of all ages. According to the World Health Organization's annual estimates, there are 7.4 million trichomoniasis cases each year in the United States, with over 180 million cases reported worldwide.

It is often diagnosed in patients who are already infected with other STDs such as gonorrhea or non-gonococcal urethritis (NGU). There is a significant difference in racial distribution of the infection:

• Caucasian, 1.2%;
• Latino, 2.1%;
• African American, 6.9%;
• Asian, 1.8%;
• Native American, 4.1%.

Symptoms of trichomoniasis

The problem is that trichomoniasis, like many other STDs, often occurs without any symptoms. Men almost never have symptoms, while women can have symptoms and they usually appear within four to 20 days after the exposure. Trichomoniasis is primarily an infection of the uro-genital tract. The urethra is the most common site of infection in man, while the vagina is the most common site of infection in women.

Women

• discharge from your vagina that is green or yellow.
• discharge from your vagina that smells like fish, especially after sex.
• itching, red, or sore vagina.
• blood spotting in vaginal discharge
• swelling in the groin
• swollen and irritated vagina and cervix
• urinating more than usual
• worsening symptoms when menstruating
• pain when you urinate.
• pain when you have vaginal intercourse.
• lower abdominal pain in rare cases

Men

• infection of the urethra or prostate gland, which is involved in semen production
• a small amount of clear discharge from your penis.
• burning or itching around the opening of your penis.
• burning feeling in your penis after having sex.
• pain when you urinate.
• tingling inside the penis

It is very important to know that person may not have symptoms but still have the infection.

Risk factors for developing trichomoniasis

Risk factors for T vaginalis include the following:

• Infection with other STDs, especially gonorrhea
• Four or more lifetime sex partners
• Sexual contact with an infected partner
• Not using barrier contraception

Complications of trichomoniasis

It is proven that untreated trichomoniasis can be linked to several other conditions of which some are very serious. The prolonged infection may cause changes in the tissue of the cervical surface. It can also lead to an increased risk for HIV infection. Infected pregnant women are at risk for premature birth, low birth weight, and infection or rupture of the placenta. Inflammation of the prostate and bladder are associated with trichomoniasis in men.

Diagnosis of trichomoniasis

Diagnosis can be made by:

Pelvic examination
A pelvic examination reveals red blotches on the vaginal wall or cervix. It may also reveal a distinctive, inflamed cervix. During the pelvic exam, doctor is usually able to see small red sores inside the vagina or on the cervix. For both men and women, a health care provider must perform a physical examination and laboratory test to diagnose trichomoniasis. The parasite is harder to detect in men than in women.

Examination under a microscope
A wet prep or microscopic examination of discharge demonstrates rapidly moving trichomonads in the vaginal secretions. Sensitivity is poor, 40-60%.

Pap smears
A pap smear may also detect the presence of the organism. Sensitivity is similar to that of wet mount, 60%.

Culture Tests
A culture of the organism or an antibody test may be done, especially in men, as relatively few of the parasites are found in discharges from the penis

OSOM Trichomonas Rapid Test
This is a very modern because it uses color immune-chromatographic “dipstick” technology with monoclonal antibodies and results are read within 10 minutes. The sensitivity is 83.3% and specificity is 98.8%.

BD Affirm VPIII Microbial Identification Test
This test uses nucleic acid hybridization technology. The great thing about this test is that it has sensitivity of between 90 and 100%.
In men, the disease can be hard to diagnose without special culture techniques, but men are treated presumptively if infection is diagnosed in female sexual partners.

Polymerase chain reaction- PCR
PCR is a very good, efficient and modern diagnostic tool based on DNA amplification and detection using known primers to specific genes. It also has good sensitivity ( 97%), and specificity (98%). In males, performing PCR on urine sediment rather than urethral swabs improves detection rates.

Treatment of trichomoniasis

The good news about this infection is that it can be completely cured. The most common drug used for this purpose is called Metronidazole and can be used in combination with Tinidazole. Metronidazole is usually administered in a single dose. It disrupts the helical structure of the DNA within microbes, especially Trichomonas vaginalis, preventing nucleic acid synthesis and eventually leading to cell death.

Possible side effects from using these medications include:

• nausea,
• headache,
• abdominal cramping
• seizures and neurological damage

If someone is allergic to some of these medications then some topical medicines, or medicines applied to the skin, may be used. All women and men diagnosed with trichomoniasis should be treated. Even without symptoms, it can be passed to others.  The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment.

There are some rules about the treatment and they include:

• Regular sexual partners should be tested and treated to prevent reinfection.
• Person should not have unprotected sex until therapy is completed in both yourself and your partners, and symptoms have resolved.
• Avoid alcohol until 24 hours after the treatment as the combination of the antibiotics and alcohol may cause nausea and vomiting.
• Having trichomoniasis once does not protect a person from getting it again.
• Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms.

Trichomoniasis and pregnancy

Trichomoniasis can cause several problems during pregnancy such as premature delivery or delivering a low-weight baby. Experts from this field recommend that women with trichomoniasis who have symptoms should be treated, but women without symptoms do not need to be treated. Even when woman wants to take full treatment, many experts believe that women shouldn't take metronidazole during the first 3 months of pregnancy because it may hurt the baby.

Prevention of trichomoniasis

There are things you can do to protect yourself from trichomoniasis:

Don’t have sex
The best way to prevent trichomoniasis is to practice 100% abstinence. This means no vaginal, oral, or anal sex at all.

Faithfulness
When someone is having a sexual relationship with only one partner who has been tested for trichomoniasis and is not infectedthere is no chance that he or she may contract this parasite.

Use of condoms
If person uses a condom every time he or she has vaginal, anal, or oral sex it greatly reduces the chance of getting the trichomoniasis.

Don’t share swimsuits or towels
Because the trichomoniasis parasite can live outside the body for up to 45 minutes, the infection can be contracted through contact with damp or moist objects that have the parasite on them.

Sexual health
Some methods of birth control like birth control pills, shots, implants, or diaphragms, will not protect you from STDs.  Talk frankly to your doctor or nurse and your sex partner(s) about any STDs you or your partner have or had. Try not to feel embarrassed about it.