Vulvovaginal Disorders:

An algorithm for basic adult diagnosis and treatment

TRICHOMONAS

What is Trichomonas infection (trichomoniasis) and how is it transmitted?

Trichomonas vaginalis is a microscopic, single-celled, protozoan parasite that infects people throughout the world.

Infection with Trichomonas is called trichomoniasis (trick-oh-moe-nye-uh-sis). Trichomoniasis is one of the most common

sexually transmitted infections, mainly causing symptoms in sexually active women. In North America, it is estimated that

more than 8 million new cases are reported yearly.

The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of

infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital

area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women,

but men usually contract it only from infected women. Infection is more common in persons who have multiple sexual

partners. A common misbelief is that infection can be spread by a toilet seat; this isn't likely, because the parasite cannot

live long in the environment or on objects.

What are the signs and symptoms of infection?

Some people find out they have trichomonas only if their sexual partner tells them that they were exposed, while others

have very noticeable symptoms which may include:

For Women: (symptoms usually appear in women within 5 to 28 days of exposure)

• foul smelling or frothy, green, vaginal discharge,

• vaginal itching or redness

• painful sexual intercourse,

• lower abdominal discomfort

• the urge to urinate frequently

For Men: (most men do not have symptoms, but if so they may include)

• burning with urination or ejaculation and/or

• penile discharge

• the urge to urinate frequently

How is trichomoniasis diagnosed?

For women this usually requires a pelvic exam to collect vaginal samples for examination. Diagnosis is most commonly

made by viewing the parasite under a microscope. Sometimes it can be difficult to diagnose and a culture or other

laboratory test may be performed to confirm the diagnosis. The lab results are available in 3-7 days. On occasion,

Vulvovaginal Disorders:

An algorithm for basic adult diagnosis and treatment

presence of trichomonas parasites is detected in urine or in a Pap smear. However, suspected infection detected by a Pap

smear should be confirmed by more specific diagnostic methods. For men, diagnosis is made by collecting specimens

from the urethra or detecting parasite DNA in the urine.

How is trichomoniasis treated?

Trichomoniasis can usually be cured with prescription antibiotics, either metronidazole (Flagyl) or tinidazole, given by

mouth in a single dose. The symptoms of trichomoniasis in infected men may disappear within a few weeks without

treatment. However an infected man, with or without symptoms, can continue to infect or re-infect a female partner until

he has been treated. Therefore, both a woman and her partner should be treated at the same time to eliminate the

parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment

and have no symptoms, which generally takes about a week.

Flagyl (metronidazole) is used to treat trichomonas- usually with a single dose. This antibiotic has a metallic

taste. Alcohol must be avoided while you are on Flagyl. Sometimes women who take antibiotics such as Flagyl

develop a yeast infection later. Vaginal forms of metronidazole are not adequate to treat trichomoniasis.

What are the complications of trichomoniasis?

If you have trichomoniasis, you are at risk for having other sexually transmitted infections (STIs) and should be tested. In

addition, genital inflammation caused by trichomoniasis can increase a woman’s susceptibility to HIV infection if she is

exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex

partner(s).

How can I avoid getting infected with trichomonas?

You can avoid getting trichomoniasis or any STI by abstaining from sexual activity or by having sex only with a non-

infected partner who only has sex with you. The risk of acquiring infection can be reduced by proper use of latex

condoms and possibly by maintaining good vulvar hygiene. Limit your sexual partners. The more sex partners you have,

the greater your risk of encountering someone who has this or other STIs. If you are infected, your sexual partner(s)

should be treated to prevent reinfection. The body does not develop immunity to trichomonas and following successful

treatment, people can still be susceptible to re-infection if exposed.

How does trichomoniasis affect a pregnant woman and her baby?

Pregnant women with trichomoniasis may have babies who are born early or with a dangerously low birth weight. Infants

born to infected mothers may contract infection during delivery. Signs and symptoms in neonates may include fever,

respiratory problems, urinary tract infection, nasal discharge, and/or vaginal discharge.

Vulvovaginal Disorders:

An algorithm for basic adult diagnosis and treatment

How can a child get trichomoniasis?

Infants: If an infant is infected, it is possible that the mother spread infection during childbirth. The mother should be

checked for infection. Young children: Because trichomoniasis is an STI, infection in a young child may indicate sexual

abuse. Teenagers: Because trichomoniasis is an STI, infection in a teenager may indicate sexual activity or sexual abuse.

In the last two cases an evaluation for other STIs is recommended.

How can I get more information?

 Ask your health care provider.

 Visit the HVMA website: http://www.harvardvanguard.org/health-and-wellness

 Call the American Social Health Association or CDC Info: 1-800-227-8922 or 1-800-CDC-INFO

 Visit the American Social Health Association website: http://www.ashasexualhealth.org/

Visit the CDC website: www.cdc.gov/STD/Trichomonas/STDFact-Trichomoniasis.htm