Understanding Trichomoniasis: Diagnosis and Effective Treatment Options

Trichomoniasis, often called trich for short, is a common sexually transmitted infection that can be easily cured in about a week. However, leaving it untreated can have serious adverse outcomes. Please continue reading to find out how healthcare providers treat trichomoniasis.

What is trichomoniasis?

Trichomoniasis is one of the most common sexually transmitted infections. It is caused by a parasite called Trichomonas vaginalis. It is more common in females and Black people, but all sexually active women and men are at risk of getting a trich infection. Trichomoniasis affects an estimated 3.7 million people in the United States. Risk factors include unsafe sex (not using condoms). Another risk factor is having multiple sexual partners.

What are the symptoms of trich infections?

Only about one-third of people with a Trichomonas vaginalis infection develop symptoms.

Symptoms of trichomoniasis in females include:

Redness, soreness, or irritation of the vagina and cervix (strawberry cervix)
Increased vaginal fluids
White, yellow, or green-colored thin or foamy vaginal discharge with a fishy smell
Painful intercourse

Symptoms of trichomoniasis in males include:

Itching or irritation of the penis
A frothy penile discharge
Painful urination
Burning with ejaculation

How does trichomoniasis spread?

Even asymptomatic trichomoniasis is contagious and can spread to sex partners through vaginal-penile, vaginal-vaginal, oral, and anal sex as well as skin-to-skin contact of the genitals.

Trich does not spread through non-sexual touching, kissing, holding hands, or sharing food or drinks. However, in addition to the genitals, it can also infect the anus, mouth, and hands.

Trichomoniasis does not occur due to poor hygiene. A urinary tract infection cannot lead to trichomoniasis.

How is trichomoniasis diagnosed?

Doctors can diagnose trichomoniasis based on your symptoms, pelvic exam, and lab tests. Penile or vaginal swabs of penile or vaginal secretions can be sent to the lab to look for Trichomonas vaginalis isolates.

Your doctor may recommend testing for other sexually transmitted infections at the same time. They may also obtain a urethral swab and urine sample to check for infections of the genitourinary tract.

What is the fastest way to cure trichomoniasis?

The fastest way to cure a Trichomonas infection is to take antibiotics.

What are the best trichomoniasis treatments?

Oral metronidazole is commonly prescribed for Trichomonas vaginalis infections. Your healthcare provider may also recommend using topical vaginal gels, creams, or pessaries for local symptom relief, but they will prescribe antibiotics (metronidazole) to cure the infection. Tinidazole is an alternative treatment to metronidazole that may also be prescribed.

How long does trichomoniasis take to go away?

The metronidazole regimens used for the treatment of trichomoniasis are as follows:

In females: Metronidazole 500 milligrams (mg) twice a day by mouth for 7 days
In males: Metronidazole 2 grams (g) by mouth single dose

Men and women treated with these regimens have 95% cure rates. In women, taking multiple doses (500 mg twice daily for 7 days) instead of a single dose has been found to reduce by half the number of women who retest positive after 1-month.

Metronidazole dosage recommendation is recommended for women with HIV -- metronidazole 500 mg by mouth twice daily for seven days. Similarly, men with HIV infection should receive the same treatment as men without HIV.

Do not have sexual intercourse for 7 days after finishing the course of antibiotics for treatment of trichomoniasis. Having sex too soon can result in re-infection. You should go back to see your healthcare provider after 3 months and have further testing to make sure the infection is cured.

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Do sexual partners need to be treated for trichomoniasis?

Yes, sexual partners (both female and male partners) need to be treated for trichomoniasis at the same time. Concurrent treatment is necessary to prevent recurrent infections (passing the infection back and forth).

Can I treat trichomoniasis myself?

You cannot treat trichomoniasis yourself. Home care treatment will not get rid of the infection. Only a doctor can prescribe treatment for trichomoniasis. Without proper treatment for trichomoniasis, the infection can last months or even years. While you are infected, you can pass trich to every sexual partner.

Why does my trich keep coming back?

Recurrent trichomoniasis and treatment failure can occur due to drug resistance (metronidazole resistance), lack of adherence to the prescribed treatment, or reinfection from an untreated sex partner. Reinfection happens to about 1 in 5 people within 3 months after treatment but can be avoided if both partners are treated at the same time.

Why do you need to avoid drinking alcohol while on metronidazole?

If you drink alcohol while taking metronidazole, it can cause an unpleasant reaction lasting 30 minutes to several hours. The symptoms can include headache, nausea, vomiting, flushing, sweating, and increased thirst.

What happens if you don’t treat trichomoniasis?

If left untreated, trichomoniasis can increase your risk of getting other sexually transmitted infections, including a human immunodeficiency virus (HIV) infection. It can also increase your risk of passing on an HIV infection to your sexual partners. Read more: HPV Vs. HIV: What's The Difference?

Other complications of untreated trichomoniasis include adverse pregnancy outcomes and an increased risk of pelvic inflammatory disease and cervical cancer. Pregnant women with vaginal trichomoniasis are more likely to have premature rupture of membranes, preterm delivery, and a low-birth-weight baby.

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