Trichomoniasis: Symptoms, Diagnose & Treatment

Trichomoniasis is a fairly common sexually transmitted infection (STI) that commonly presents as a foul smelling vaginal discharge in females. This is caused by the organism, Trichomonas vaginalis and is transmitted by direct sexual contact.

The individual carrying the infection may often remain asymptomatic for months before presenting with vaginal discharge. Men are usually asymptomatic, but may occasionally develop urethritis (inflammation and infection of the urethra). About 70% of men who have infected female sexual partners are found to carry the infection and can transmit it.

Risk factors of Trichomoniasis

• Avoidance of condoms during sexual intercourse
• Multiple sexual partners
• Presence of other STIs
• Previous Trichomonas infection

Symptoms of Trichomoniasis

Trichomoniasis is very often asymptomatic. Only about 30% of those infected may show symptoms as follows

• Foul smelling, thin, vaginal discharge
• Pain
• Itching and burning sensation in the vagina
• Burning during urination with increased frequency (In men and women)
• Lower abdominal pain
• Dyspareunia or pain during intercourse

Diagnosis of Trichomoniasis

Due to the frequent absence of reliable symptoms in those infected, clinical examination is always supplemented with laboratory tests to assess for infection.

• Physical Examination with Pelvic Exam. This is done to look at the nature of the discharge, check for spread of infection in the female reproductive organs. A swab of the discharge is taken for further analysis
• Saline Wet mount microscopy: The organism has a flagella (tail), which helps it move rapidly in fluids. Viewing a drop of discharge mixed with saline under a microscope can identify the moving organisms, confirming diagnosis
• Nucleic Acid Amplification Test: This is very accurate at identifying the organism based on testing for it’s RNA (Ribonucleic acid). This test is done if microscopy cannot identify the organisms. In Men, this is the preferred test.
• Tests for other STIs: Several STIs are asymptomatic for along time before presentation. Simultaneous testing may be done when they are suspected.

Complications of Trichomoniasis

• Increases chances of getting other STIs
• The infection may progress into the uterus causing pelvic inflammatory disease
• In pregnancy, can lead to preterm labour, low birthweight and transmission to the new baby.

Treatment of Trichomoniasis

The infection is effective treated using Metronidazole or Tinidazole in both men and women. A single high dose Metronidazole (2g) or 500 mg twice daily for 7 to 10 days may be given.

In pregnant women, Metronidazole is the recommended medication.

The sexual partner of the individual is contacted and evaluated for trichomoniasis and other STIs, and treated appropriately.

References

1. Sobel JD. Trichomoniasis. https://www.uptodate.com/contents/search. Accessed March 31, 2019.

2. Trichomoniasis — CDC fact sheet. Centers for Disease Control and Prevention. Accessed March 31, 2019.