The Lowdown on STDs: Trichomonas

Dr. LazenbyBeginning February 23rd, MUSC Women’s Health will offer a specialty clinic for sexually transmitted infections (STI’s). The goal of the clinic is to offer screening, treatment, and counseling regarding STI’s.  We welcome women to bring their partners.

In celebration of these new services, Women Speak will be introducing a blog series about sexually transmitted infections.  Each installment will discuss a common STI, symptoms, diagnosis, treatment, pregnancy complications, long-term consequences, and prevention.  In this inaugural installment of the “The Lowdown on STD’s,” I will discuss Trichomonas.

Trichomonas vaginalis is the second most common STI in the United States with 3-4 million cases diagnosed each year.  Unfortunately, women of color are disproportionately represented.  The rates of Trichomonas in African American women seeking STI screening have been recorded as high as 13%.  In comparison to other STI’s, which are more common among adolescents, Trichomonas is frequently diagnosed in older women. 

Trichomonas is unique among sexually transmitted infections because it is not a virus or bacteria.  T. vaginalis is a single-celled protozoa that swims using a flagellated tail.  It is large enough to be seen using a low-power microscope.  (See picture)Trichomonas
 
In women, Trichomonas is a common cause of vaginal discharge and vulvar symptoms.  Men infected with Trichomonas most commonly have painful urination. Like other sexually transmitted infections, Trichomonas enters a woman’s body during sexual contact with an infected partner. It can live in both the vagina and around the opening of the bladder or urethra. 

Not all women who are infected by Trichomonas have symptoms.  For those that do, the most common is a foul-smelling vaginal discharge.  Other symptoms include: painful urination, vaginal and vulvar itching, and spotting after intercourse or between periods. If you are concerned about infection or have any of these symptoms, you should consult your physician.

Trichomonas can be diagnosed by your doctor.  A pelvic exam is required in which specimens are collected for microscopic examination or culture.  Most results are available in 1-5 days. It is treated with antibiotics, which should be taken by both partners.  Patients cannot drink alcohol within 48 hours of taking these medications.  If your partner is unable to receive treatment, it is necessary to use condoms to avoid re-infection.

During pregnancy, infection with Trichomonas has been associated with preterm labor and low birth weight.  Treatment of symptomatic women during pregnancy is recommended.  Untreated infection can lead to long-term consequences.  Women infected with Trichomonas are at an increased risk of acquiring HIV, the virus that causes AIDS.  Trichomonas can also increase the risk of infection with other common STI’s.  If Trichomonas is present during or shortly after gynecologic surgery, women can develop abscesses that require a longer period of therapy.  Screening and treatment are imperative to avoid these complications.

Trichomonas infection can be avoided by consistent use of condoms.  Latex condoms are the only form of birth control that prevents STI’s.  If you have any questions regarding Trichomonas or STI’s, please feel free to send questions via the comment function or attend our specialty clinics at MUSC Women’s Health.

by:  Gweneth Lazenby, M.D.

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Comments

March 1. 2009 22:56

Who cares about Trich? I want to know if there is chlamydia or gonorrhea!

Sharon

March 5. 2009 08:12

Okay..so i recently was diagnose with te trish...my bf was out of town and when he was gne i toook the med..2 days after when he came back he drank alcohol so i told him to wait a day at least...but we ended up having sex that night..so the nxt day he took the med and i took another dose just i case i got re infected...will the medicine still work right away?....and how long do we have to wait till we can get retested and make sure we are both clean?

Catrina

March 5. 2009 17:22

Catrina,
By having sex with your partner before he was treated, you were most likely reinfected despite your treatment. It sounds as though you both took Metronidazole (Flagyl) the day after you had sex. If you both took the medication that day, it is usually advised to wait at least 1 week before having sex again. The antibiotics may kill most the Trichomonas right away, but it is probably best to wait a few days to insure that the infection has cleared. It would be a good idea to speak with your physician to see if they would like you to return in a few weeks and be retested.
As a rule, when you and your partner are being treated for a sexually transmitted infection, it is essential that you both take the medication and abstain from sex until after treatment to avoid reinfection. On partner being treated is not enough.
Catrina, thank you for this question. I think many women find themselves in this situation.
Dr. Lazenby

Gweneth Lazenby

March 5. 2009 17:26

To Sharon,
Trichomonas is the 2nd most common STI in the United States. Women infected with Trichomonas are at increased risk for acquiring more serious and less treatable infections such as herpes and HIV. Trichomonas may play a role in preterm labor as well, which can lead to premature birth and unhealthy infants. By ignoring this common infection, we may leave many women vulnerable to more serious diseases.
Thanks for you comment.

Gweneth Lazenby

March 6. 2009 04:09

I guess that many STD's are transmitted during sex that involves drugs or alcohol as in the case above. I guess I always thought trich was no big deal. Does douching remove the trich? How would a male present with this?

Sharon

March 6. 2009 04:11

Is there a new medication for Trichamoniasis? I heard that both metronidozole and this new medication have been implicated in carcinogenesis in animal studies. Is this true? Should this be a concern for women being treated for trich? Are there alternative therapies?

Jessice

March 6. 2009 05:32

thank you...I feel so much better now i just wanted to know if taking the medicine right away will kill the bacteria..in my head i was thinking that maybe all the bacteria wasnt in yet.and that i shouldve waited to take the med..but it was right for me to take it right away?..well the next day?.and yes we have abstin from sex and will use condoms until we are secure that we are both clean.. one more qstion after he took the med he started feeling a burning sensation when he went pee only for 1 day..but before he never had any sympotoms..is that normal?

Catrina

March 7. 2009 06:41

wait i just realize is this the same thing as trichomoniasis?

Catrina

March 10. 2009 01:36

To Sharon,
Thank you for your further questions regarding Trichomonas. Douching does not remove Trichomonas from the vagina. The only treatment is antibiotic therapy with either Metronidazole or Tinidazole tablets.
Men most often are asymptomatic. When men have symptoms, the most common is burning with urination.
Thank you for your questions.

Gweneth Lazenby

March 10. 2009 01:40

To Jessice,

Thank you for your question regarding Metronidazole. This drug is not a carcinogen (a drug that may cause cancer) in humans or a teratogen (a drug that may cause birth defects) in babies.
Unfortunately, there are only two medications for the effective treatment of Trichomonas, and they are in the same class. These medications are Metronidazole and Tinidazole. If a woman has an allergy to these medications, it is recommended that she become "desensitized." This is a safe way of delivering a necessary medication in very small doses so that an allergic patient can be treated for diseases that only respond to a specific antibiotic.

Gweneth Lazenby

March 10. 2009 01:45

Catrina,

Thank you for your further questions. Your partner's burning with urination after Trichomonas treatment is not a common side effect. The most common symptom of Trichomonas infection or "Trichomoniasis" in men is burning with urination. However, other infections such as chlamydia or gonorrhea can present this way in men. He should see a physician.
Regarding your timing of treatment, taking Metronidazole 2 grams by mouth at once is the correct treatment. If you and your partner were treated simultaneously with the correct doses, you should be treated. But, you should wait for approximately 1-2 weeks after treatment before having sex. In your particular case, I think you should see your physician to determine the best management.
Best of luck.

Gweneth Lazenby

March 13. 2009 18:14

Hi my name is Tisha
i was just treated for tricch. is there any way you can tell how long it was there. i had no symptoms whats so ever.

Tisha

March 16. 2009 18:56

I heard that Trish can cause vaginal bleeding? Is that true? Can it hurt my biscuit?

Jan

March 19. 2009 06:37

I read this about metronidozole:
The use of metronidazole in pregnancy is controversial. The drug is mutagenic in bacteria and carcinogenic in rodents, and although these properties have never been shown in humans, concern for these toxicities have led some to advise against the use of metronidazole in pregnancy (7,8). However, no association with human cancer has been proven (8,9).
Is this true? If you search the web, you will find this information. I was a little concerned. Is it better to live with Trish or get it treated?

Jessica

March 21. 2009 08:23

Do condoms protect from transmitting trachachomonas? Do guys always have symptoms?

Jessica

March 26. 2009 11:16

To Jessica,
Concerning male symptoms: most men are asymptomatic or do not have symptoms of Trichomonas. If an infected man does report symptoms, the most common is burning with urination.
Consistent condom use (using a condom with every act of intercourse) does prevent the transmission of Trichomonas.
Thank you for your inquiries.

Gweneth Lazenby

June 23. 2009 16:42

Hey Donna,

You said: "women can develop abscesses that require a longer period of therapy" where do these abscesses occur and is it only due to the surgery or could they occur either way if you have had a prolonged case of Trich? I think I have had trich for almost 4 years. My husband was a virgin when we married and I was not. I had been celibate for 18 monthsw before we got together. I just found out last month I had trich and He and I were treated. I believe that he has remained faithful and I read lots of articles that women can carry it around for years because regular paps do not always pick up the trich. In fact I read a few articles and studies that found that a specific DNA culture needed to be performed to find Trich! So if I had it for that long and me and my husband were both treated how long before we can not use condoms again? He hates it and I don't blame him but because it live sin his prostate I want to be on the safe side until I know for sure. My doc says to always use a condomn and I am looking at her like she is crazy! It's my husband for pete's sake! Also I took 2 pills a day for 7 days and his Doc gave him the 4 in one! Should we be concerned that he was not treated well enough? Should I be concerned about being treated again? also I seen in an article that you can get certain things when you take too much anit biotics and I had a kidney infection that sent me to the Hospital and I was on at least 3 anti's at a time could that have been a factor in my Trich case?

Tosh

June 24. 2009 20:38

I had trich and have been on metronidazole for the past 6 days (500mg twice a day for 7 days). My partner and i had sex last night, was it still transmittable to him last night?

Andrea

July 22. 2009 18:07

I'm about to get divorced behind my Trichomoniasis diagnosis. I need clear answers to the following questions:

Is it possible for me to have been Asymptomatic for at least 6 1/2 years and then suddenly become EXTREMELY symptomatic last month?

Is it possible that my husband has had this STD and been asymptomatic for 6 1/2 years and not transmitted this to me until about a month ago?

Please help. He swears he hasn't cheated this time.

Monique

July 24. 2009 15:55

I just got my yearly check up and I was told I had trich. I been having sex with this one guy for over a year. How can I break it down and tell him he need to go get tested. Do you think he knewn he had it and didn't tell me? Should I tell him cuz I'm pissed

Ashaley

July 28. 2009 07:35

To Monique,
It is possible to carry Trichomonas in the vagina and the glands around the vagina for long periods of time. Women can have flares of their infection from time to time without being recently infected. I am not aware of similar evidence in men, but it may also be the case. I would advise that you both be tested and treated appropriately.
Thank you. Best of luck.

Gweneth Lazenby

July 28. 2009 07:36

To Ashley,
Many women and men are asymptomatic of their infections. Trichomonas is no exception. It is very possible that either you or your partner had the infection for a period of time before your diagnosis. I recommend you are both treated for the infection.
Thank you.

Gweneth Lazenby

July 28. 2009 08:33

To Andrea,
Whenever you are being treated for an STI, both you and your partner should take antibiotics at the same time. We usually ask patients to wait 2 weeks before engaging in sexual intercourse again. In your case, you may want to speak to your doctor or provider and consider a repeat course of therapy.
Thank you for your question.

Gweneth Lazenby

July 28. 2009 09:31

To Tosh,
I will do my best to answer all of your questions. 1) Trichomonas can be diagnosed by a provider using a microscope, by a culture collected during a routine visit, or by a DNA test (which is not widely available), 2) Women can carry Trichomonas in their vagina for a long period of time without symptoms, 3) After you have both been treated, you should be retested for infection. If it has resolved in both partners, then you no longer need to use condoms, 4) Trichomonas can be treated with a 1x course of antibiotics or a 7 day course. Either are acceptable. 5) Antibiotic use does not cause Trichomonas infection. Trichomonas is only transmitted through intercourse.
I advise you and your partner to be seen together in order to resolve your issue.
Thank you.

Gweneth Lazenby

August 16. 2009 20:12

My fiancee and I both took 4 pills each on a friday durring the day. We had sex the next day at night. I saw that it is advised to wait a week, but if we both got treated at the same time are we still at risk in getting reinfected? I have extra pills to treat the infection and I am not sure if we should try taking the antibiotics again just to make sure that we are not infected.

Elizabeth

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