Trichomoniasis is the most common of the curable STD's (sexually transmitted diseases) in the world. In some inner city US STD clinics, the infection rate is around 25%.1 As the full word is bit of a mouthful, many people simply call it trich - pronounced trick.
It is caused by a single celled protozoan parasite called Trichomonas vaginalis.
According to the World Health Organization, this infection accounts for almost half of all curable infections worldwide,.1
People are often found to have it at the same time as having other STDs, particularly gonorrhea.
The majority of women with this infection (trichomoniaisis vaginitis) also have bacterial vaginosis. As they are both caused by pathogenic bacteria "taking over" the vulvovaginal area, that is not surprising. This means that if you still have a discharge after trich has been treated, you probably still have some other infection.
Trichomoniasis is an STD. The incubation period before the appearance of the first trichomoniasis symptom is not known, but test-tube studies suggest that symptoms will show within 4 to 28 days.1
Below, I cover symptoms of trich in both women and men.
Symptoms in women include vaginal discharge, strong smell and itchiness. Some women have lower abdominal pain and some have pain with intercourse.
42% of women with trich have a vaginal discharge, 50% have odor, and 22 to 37% have redness and swelling. Almost half of all women have NO trichomoniasis symptom.1
This is one of the most worrying aspects of this STD.
Although often described as being a frothy discharge, it is actually frothy in only about 10% of patients. There is often a yellow-green vaginal discharge but again it may vary in color.1
Colpitis macularis (strawberry cervix) is a specific clinical sign for this infection but is usually detected only by colposcopy and rarely during routine examination.
The urethra is also infected in the majority of women and some women experience pain during urination.
Vaginal pH is greater than 4.5 in most women, but it is possible for it to be normal.1
It is believed that the inflammation caused by trich can increase a woman's chance of catching HIV if she is exposed to the virus.2
Bacterial vaginosis is often present at the same time so if a woman has a discharge after trich has been treated, then that should be followed up.
The majority of men do not show any symptom of trichomoniasis. If they do, it is usually a temporary irritation inside the penis. Some men have a slight discharge and slight burning after urinating or sex (after ejaculation or cumming).2
In both men and women, if signs of trich are noticed, sexual partners should be told and sexual intercourse stop until after treatment and symptom free.
The organism is transmitted almost exclusively by sexual activity, although survival on items such as bedding and clothing has been documented.1 It is seen as an indicator of high-risk sexual behaviour and is equally spread amongst age groups.1
It is usually sexually transmitted through penis to vagina intercourse or vulva to vulva contact with an infected partner. Women can get trich from either men or women but men usually only catch it from women.2
One study showed that most of the male sexual partners of the women in the study were infected.3 Treatment is usually by a single oral dose of a prescription drug. Immediate replacement with probiotic bacteria will help to avoid pathogens moving in immediately after treatment.
Some women have had metronidazole side effects but if this happens to you it can be prevented.
Women with STD trich may have babies with low birth weight or who are born early. Treatment for pregnant women is VITAL.
Treating this common STD (Trichomoniasis vaginitis) has never been easier. It is very common and very curable.
Dosage for treating trich is currently 2 g taken orally in a single dose of either metronidazole or tinidazole.
In trials, metronidazole had a cure rate of 90 to 95% and tinidazole had a cure rate of 86 to 100%. It was believed that the rates would be even higher if sexual partners are treated too.2
One study showed the majority of male sexual partners were infected.3 Sexual partners MUST be treated. Symptoms often seem to disappear in men but he will still have the infection even though you can't see it and will reinfect his sexual partners.
It is suggested that you avoid sex ('fraid so!) until both of you have been treated and are symptom free. Otherwise, you're simply reinfecting each other. You do NOT develop an immunity to it. If you're exposed to Trichomonas vaginalis again, you'll likely get it again.
2.5 to 5% of all cases of this STD have some level of resistance to treatment with metronidazole and unfortunately this figure is rising as the "bug" that causes it becomes more resistant (it is actually a parasitic protozoa). This can usually be overcome by a higher dose of oral metronidazole 1
Some women are having side effects with trichomoniasis treatment because they are overly sensitive to the two standard drugs used - metronidazole and tinidazole.
A study of 59 women revealed that the two most common symptoms were itching (urticaria) and swelling of the face (facial edema.)4
Doctors can treat this metronidazole hypersensitivity quite successfully. Fifteen women were treated to desensitize them and the treatment got rid of the trich in all cases. Compare this against the seventeen women who were treated with alternative vaginal treatments and in those cases only five of the infections were successfully treated.4
The doctors concluded that "metronidazole desensitization was effective in the management of women with nitroimidazole hypersensitivity."4
So if you're having a bad reaction to trich treatment, talk to your doctor about this desensitization program.
The Centers for Disease Control and Prevention suggest either a single oral dose of metronidazole or tinidazole as the first choice in trich treatment.
1. Jane R. Schwebke and Donald Burgess. Trichomoniasis. Clin Microbiol Rev. 2004 October; 17(4): 794?803. doi: 10.1128/CMR.17.4.794-803.2004.
2. Centers for Disease Control and Prevention
3. Marcia M Hobbs, Dana M Lapple, Lisa F Lawing, Jane R Schwebke, Myron S Cohen, Heidi Swygard, Julius Atashili, Peter A Leone, William C Miller, and Arlene C Sena. Methods for Detection of Trichomonas vaginalis in the Male Partners of Infected Women: Implications for Control of Trichomoniasis. J Clin Microbiol. 2006 November; 44(11): 3994?3999.
4. Donna J. Helms, Debra J. Mosure, W. Evan Secor, Kimberly A. Workowski. Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity. American Journ of Obstret and Gyn, Volume 198, Issue 4, Pages 370.e1-370.e7 (April 2008)