An Overview of Trichomoniasis

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Trichomoniasis is a sexually transmitted disease (STD). It is one one the most common STDs and may be referred to as "trich." The symptoms include itching, irritation and discharge in women, and pain with urination in men. It is caused by a parasite, can be diagnosed with a physical exam and a microscopic analysis, and it is treatable with Flagyl (metronidazole), an antimicrobial. 

Symptoms

The symptoms of trichomoniasis may begin between several days to a month after you become infected, and there can even be a delay of several months before symptoms even surface. In fact, many people do not have symptoms at all, but can still spread the infection to others. Women are more likely than men to experience symptoms if they become infected with trichomoniasis.

Symptoms in Women

Symptoms in women are usually more noticeable than the symptoms in men. Women generally experience symptoms of trichomoniasis within 1 to 4 weeks of initial infection.

The symptoms of trichomoniasis in women include:

  • Irritation and itching of the vagina and surrounding area
  • Frothy, colored vaginal discharge
  • Strong vaginal odor
  • Pain with intercourse
  • Pain when urinating
  • Trichomoniasis can also negatively affect the outcome of a pregnancy. Pregnant women infected with the parasite are more likely to have a pre-term birth and are more likely to give birth to a low birth weight baby.

Symptoms in Men

Most men with trichomoniasis don’t have any symptoms. When they do, their symptoms are generally mild and include:

  • Pain when urinating
  • Pain when ejaculating
  • Discharge
  • The discomfort of the penis

Trichomoniasis and HIV

If you have trichomoniasis, you are more susceptible to infection by HIV, the virus that causes AIDS. If you are HIV positive, trichomoniasis also makes it more likely that you will pass HIV to your sexual partners. There is a stronger association between trichomoniasis and HIV  for women than there is for men. 

Causes 

Trichomoniasis affects both men and women and it is caused by a single-celled parasitic organism known as Trichomonas vaginalis. The infection is sexually transmitted and can be spread by sexual intercourse as well as by skin-to-skin contact involving the vagina or penis. The parasite is able to live in and around the vagina or inside the penis and is not normally associated with effects of other areas of the body. It is not spread by shaking hands, touching, or kissing.

How It's Spread

The CDC estimates that more than 3 million people in the United States are infected with trichomoniasis. The more common and prevalent it is, the higher the likelihood of getting the infection. If you have unprotected sex with someone who may be infected, this makes you more likely to contract the infection yourself. 

Effects on the Body

In women, trichomoniasis causes a vaginal infection called vaginitis. In men, it infects the urethra, the tube inside the penis that carries sperm and urine. The parasite invades the layer underneath the skin and produces an inflammatory reaction. The presence of the parasite and the resulting inflammation produces the characteristic itching, pain, discharge, and odor associated with trichomoniasis. 

Diagnosis

The symptoms of trichomoniasis are somewhat vague and similar to the symptoms of skin conditions or other STDs. A medical appointment is necessary for a definitive diagnosis, especially because there is a prescription anti-parasitic treatment that can cure the infection. 

How the Organism Is Identified

For both men and women, samples can be tested for the parasite itself, which can be visualized under a microscope. A polymerase chain reaction (PCR) test, which can detect the genetic components of the parasite, may be also used in diagnosing the infection. 

Diagnosis in Women

If you have trichomoniasis, your physical examination may show irritation of the vagina as well as discharge, and there may also be a characteristic odor. Trichomoniasis can also cause irritation of the cervix, which is inside the body and can only be visualized with a medical examination. 

A swab of the vagina, urethra (tube for urine), or cervix provides a small sample of vaginal secretions. Your doctors can then look at this sample under a microscope. This diagnostic method is called using a wet mount. It can be used to visualize the parasite itself.

The parasite that causes trichomoniasis is not always visible on a wet mount, though. Your doctors may also culture the vaginal secretions in a special medium to allow the organism to grow, increasing the chances of identifying it. A urine test may also be used for diagnosis. 

Diagnosis in Men

The physical examination is rarely abnormal in men who have trichomoniasis infection. If you have symptoms of the infection, your doctor may test for the infection using a urine sample or a urethral swab. 

Treatment

The treatment of trichomoniasis is generally effective if you are otherwise in good health. It is generally treated with a single oral dose of Flagyl (metronidazole) 2 grams or Tindamax (tinidazole) 2 grams.

If you have been treated and the infection did not resolve, you may need a prescription for 500 mg of metronidazole by mouth to take twice per day for seven days. These medications are also used for the treatment of bacterial vaginosis. There are cream and gel forms of metronidazole, but it is not effective for treatment of trichomoniasis.

You should not drink alcohol for several days when using these medications as the combination can induce a severe physical reaction characterized by high blood pressure, shortness of breath, nausea, and vomiting. 

After using the medications, it is recommended that you abstain from unprotected sexual activity for a week and until your symptoms completely clear. This is because It takes approximately one week for the medication to get rid of the infection. It is also important that your sexual partners be treated for trichomoniasis at the same time you are to reduce the risk of reinfection.

Prevention

Condoms have been shown to reduce the risk of infection from trichomoniasis. They should be used consistently if either partner is infected or might be at risk of infection. The parasite can also be transmitted by fingers, sex toys, or other objects.

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