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What is Trichomoniasis?
Trichomoniasis (often called “trich”) is a common sexually transmitted disease caused by the parasite Trichomonas vaginalis. This single-celled protozoan parasite primarily infects the urogenital tract, including the urethra, vagina, and prostate gland.
Trichomoniasis is the most common curable STD in the United States, affecting both men and women, though women are more likely to experience symptoms. Like many other STDs, trichomoniasis often causes no symptoms, which means many infected individuals may unknowingly spread the infection to their sexual partners.
If you’re concerned about trichomoniasis or other STDs, call (866) 566-8711 to learn about testing options.
How Common is Trichomoniasis?
- Approximately 3.7 million people in the United States have trichomoniasis
- Only about 30% of infected people develop any symptoms
- Women over 40 have the highest prevalence rates
- More common in women than men
- Higher rates among African Americans (13.3%) compared to other racial groups
- An estimated 7.4 million new cases occur annually worldwide
- Approximately 2.3% of women aged 14-49 in the U.S. are infected
How Trichomoniasis Spreads
Trichomoniasis is primarily transmitted through sexual contact with an infected person.
Trichomoniasis is transmitted through:
- Vaginal sex (most common route)
- Penis-to-vagina contact even without penetration
- Vulva-to-vulva contact (less common)
- Sharing sex toys that aren’t cleaned between uses
Trichomoniasis is NOT normally transmitted through:
- Oral sex
- Anal sex
- Casual contact (handshakes, hugging, sharing food)
- Toilet seats (the parasite cannot survive long outside the body)
- Swimming pools or hot tubs
- Sharing towels or clothing
Important Transmission Facts:
- The parasite can survive for up to 45 minutes on moist surfaces
- Can be transmitted when no symptoms are present
- Can be transmitted during menstruation
- Re-infection is common if partners aren’t treated simultaneously
- Can increase susceptibility to other STDs, including HIV
Trichomoniasis Symptoms
The majority of people with trichomoniasis (about 70%) have no symptoms. When symptoms do occur, they can range from mild irritation to severe inflammation.
- Frothy, yellow-green vaginal discharge with a strong fishy odor
- Genital itching, burning, or redness
- Discomfort during urination
- Pain during sexual intercourse
- Spotting or light bleeding
- Lower abdominal discomfort (less common)
- Swelling of the vulva in some cases
- Itching or irritation inside the penis
- Burning after urination or ejaculation
- Clear, white, or slightly yellow discharge from the penis
- Discomfort or pain in the urethra
- Testicular discomfort (rare)
- Symptoms may come and go
- Symptoms can appear 5-28 days after infection
- Many people never develop noticeable symptoms
- Without treatment, infection can last for months or years
- Symptoms may worsen during menstruation in women
- Similar symptoms can be caused by other conditions (yeast infections, bacterial vaginosis, UTIs)
Diagnosing Trichomoniasis
Accurate diagnosis of trichomoniasis requires laboratory testing, as symptoms can be absent or similar to other conditions:
Common Testing Methods:
- Nucleic Acid Amplification Tests (NAATs):
- Most sensitive testing method
- Can be performed on urine, vaginal, urethral, or endocervical samples
- Results typically available within 1-2 days
- Highly accurate (sensitivity >95%)
- Rapid Antigen Tests:
- Results available in 10-30 minutes
- Performed on vaginal swab samples
- Less sensitive than NAATs
- Useful in clinical settings for immediate diagnosis
- Microscopic Examination (wet mount):
- Sample of discharge is examined under a microscope
- Can identify moving parasites
- Fast but less sensitive (only detects 60-70% of infections)
- More effective for women than men
- Culture:
- Samples placed in special medium to grow the parasite
- Takes 3-7 days for results
- More sensitive than microscopy but less than NAATs
- Less commonly used due to longer wait time
When to Get Tested:
- If you have symptoms consistent with trichomoniasis
- If your sexual partner has been diagnosed with trichomoniasis
- If you have multiple sexual partners
- If you’ve had unprotected sex
- As part of routine STD screening, especially for women with new or multiple partners
- During pregnancy, as trichomoniasis has been associated with adverse pregnancy outcomes
Trichomoniasis Complications
If left untreated, trichomoniasis can lead to several complications:
- Increased risk of HIV acquisition by approximately 2-3 times
- Increased risk of transmitting HIV to sexual partners
- Pelvic inflammatory disease (less common than with other STDs)
- Infertility (rare, but possible with chronic infection)
- Cervical erosion
- Vaginal cuff cellulitis after hysterectomy
- Premature rupture of membranes
- Preterm delivery
- Low birth weight infants
- Postpartum endometritis
- Increased neonatal mortality in severe cases
- Increased risk of HIV acquisition and transmission
- Urethritis (inflammation of the urethra)
- Prostatitis (inflammation of the prostate)
- Epididymitis (inflammation of the epididymis)
- Infertility (rare, but possible with chronic infection)
- Increased risk of prostate cancer (suggested by some studies)
- Increased susceptibility to other STDs
- Persistent or recurrent infections
- Psychological distress from chronic symptoms
The Biology of Trichomonas vaginalis
The parasite that causes trichomoniasis has several unique characteristics:
- Single-celled protozoan parasite with a pear-shaped body
- Four anterior flagella that provide motility
- Undulating membrane that helps it move
- Size of 10-20 micrometers (visible under microscope)
- Anaerobic organism (doesn’t require oxygen)
- Reproduces by binary fission
- Cannot survive drying or temperatures above 104°F (40°C)
- Optimal pH for growth is slightly acidic to neutral (5.5-6.0)
- Primarily infects squamous epithelium of the genital tract
- Can attach to host cells using specific surface proteins
- Secretes proteases that can damage host tissues
- Can form pseudocysts under unfavorable conditions
Infection Process:
- Parasite attaches to epithelial cells of urogenital tract
- Releases enzymes that damage cell membranes
- Feeds on bacteria, vaginal secretions, and occasionally red blood cells
- Causes inflammatory response, leading to symptoms
- Multiplies through binary fission
- Continues cycle of infection if not treated
Trichomoniasis Treatment
Trichomoniasis is highly curable with appropriate antibiotic treatment:
-
First-Line Treatment
-
Important Treatment Considerations
-
For Metronidazole-Resistant Infections
-
Side Effects of Treatment
- Metronidazole:
- 2 grams (single dose) taken orally, OR
- 500 mg twice daily for 7 days
- Tinidazole:
- 2 grams (single dose) taken orally
- Both partners should be treated simultaneously to prevent reinfection
- Abstain from sexual activity until treatment is complete and symptoms resolve
- Alcohol should be avoided during treatment and for 24 hours after taking metronidazole or 72 hours after tinidazole
- Follow-up testing is generally not necessary if symptoms resolve
- Pregnant women can be treated with metronidazole (typically 2 grams as a single dose)
- Breastfeeding women should interrupt breastfeeding during treatment and for 12-24 hours after the last dose
- Higher doses of metronidazole (2-2.4 grams daily for 7 days)
- Tinidazole (often effective against metronidazole-resistant strains)
- Consultation with infectious disease specialists for persistent infections
- Metallic taste in mouth
- Nausea and vomiting
- Headache
- Dizziness
- Disulfiram-like reaction if alcohol is consumed (flushing, headache, nausea, vomiting)
- Darkening of urine (harmless but can be concerning to patients)
Preventing Trichomoniasis
Preventing trichomoniasis relies on safe sex practices and appropriate testing:
-
Prevention Strategies
-
Risk Reduction
- Consistent and correct condom use during vaginal sex
- Regular STD testing, especially with new partners
- Mutual monogamy with an uninfected partner
- Prompt treatment of infections
- Ensuring partners are treated to prevent reinfection
- Avoiding sharing sex toys or cleaning them thoroughly between uses
- Getting tested between partners or if symptoms develop
- Limiting number of sexual partners
- Open communication with partners about STDs and testing
- Regular gynecological exams for women
- Recognizing symptoms and seeking treatment promptly
- Avoiding douching, which can disrupt vaginal bacterial balance
Trichomoniasis and Pregnancy
Trichomoniasis during pregnancy requires special consideration:
- Premature rupture of membranes
- Preterm delivery (before 37 weeks)
- Low birth weight infants (<5.5 pounds)
- Respiratory or genital infections in the newborn (rare)
- Postpartum maternal infection
- Metronidazole is the preferred treatment
- 2 grams orally in a single dose is typically recommended
- 500 mg twice daily for 7 days is an alternative
- Treatment is recommended for all pregnant women with trichomoniasis, even if asymptomatic
- Treatment is safe during all trimesters of pregnancy
- Benefits of treatment outweigh risks
- Follow-up testing may be recommended during pregnancy
- Not routinely performed in all pregnant women
- Recommended for women with symptoms
- Consider for women with history of preterm delivery
- Consider for women with high-risk sexual behaviors
Trichomoniasis Facts and Statistics
- Most common non-viral STD in the United States
- Disproportionately affects African American women
- Peak age of infection is 40-49 years for women
- Approximately 1 in 5 will become reinfected within 3 months after treatment
- Annual cost of trichomoniasis in the U.S. is estimated at $24 million
- Higher rates in women with multiple sexual partners
- Global prevalence estimated at 5.3% in women and 0.6% in men
- Can survive on moist surfaces for up to 45 minutes
- Estimated 7.4 million new cases occur annually worldwide
The only way to know for sure is to get tested. Many people with trichomoniasis have no symptoms at all. When symptoms do occur, they can include unusual discharge, genital itching or burning, and pain during urination or sex.
While some sources suggest the infection might resolve naturally in men, there’s no reliable evidence that trichomoniasis goes away without treatment in women. Without treatment, the infection can persist for months or years and can be transmitted to sexual partners.
It’s extremely unlikely. The parasite cannot survive long outside the body and requires direct genital contact for transmission. It is not spread through toilet seats, sharing towels, or swimming pools.
Yes, you can get trichomoniasis again if you’re exposed to the parasite. Having trichomoniasis once does not make you immune. Reinfection is common, especially if partners aren’t treated simultaneously.
While trichomoniasis is not as strongly linked to infertility as some other STDs like chlamydia and gonorrhea, chronic or repeated infections may potentially contribute to fertility problems in some cases. Prompt treatment reduces this risk.
Yes, it’s possible to have trichomoniasis and a yeast infection simultaneously. In fact, the changes in vaginal environment caused by trichomoniasis may make you more susceptible to yeast infections. If you have symptoms that persist after treatment for one condition, you may need to be tested for other infections.
You should wait until you’ve completed your full course of medication and all symptoms have resolved. Additionally, you should wait until your partner(s) have been treated to avoid reinfection. This typically means waiting about a week after starting treatment.
Trichomoniasis primarily affects the urogenital tract and is not commonly transmitted through oral or anal sex. However, any genital-to-genital contact with an infected person carries some risk of transmission.
Learn More About Trichomoniasis Testing
If you’re concerned about trichomoniasis or want to get tested, call (866) 566-8711 to speak with a care advisor who can help you understand your testing options.
LocalSTDTesting is not a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician with any questions about medical conditions.
