Trichomoniasis

Inflammation of the vagina, called vaginitis is a common problem and causes disabling symptoms, and dreaded complications.

Vaginitis can be caused by bacteria, yeasts, or parasites and can lead to abnormal vaginal discharge, pain during urination or intercourse, local burning and itching, etc.

The infections can spread up to other reproductive organs and cause pain in lower abdomen and even infertility. The infections underlying vaginitis can spread rapidly due to the emerging sexual preferences.

Trichomoniasis accounts for 10 to 25% of vaginal infections. It is important to be informed about the commonest causes of trichomoniasis and treatment of this common vaginal infection.

Trichomoniasis is a widely prevalent genital infection, also called sexually transmitted disease (STD) that is caused by a parasite called Trichomonas vaginalis, which is invisible to the naked eye. It is more common and evident in sexually active young women though men are not spared.

The commonest trichomoniasis symptoms in women are;

  • Copious foamy or frothy foul smelling yellowish gray, vaginal discharge
  • Vaginal itching
  • Burning
  • Pain during urination
  • Pain during intercourse

In some women and most men, the infection may be deceptively silent. Some men may complain of a discharge from urethra, pain in the genitals, or pain or burning with urination.

Trichomoniasis spreads from person to person, usually by sexual exposure. People with multiple sexual partners are more susceptible to acquiring the infection. Usually, females spread the infection to the male partners. Infected females can spread the infection to other females, if is a homosexual relation.

The infection is unlikely to be acquired by contaminated douche nozzles or toilet seats. The parasite is not viable for long outside the human body, so the chances of person to person spread are more than those due to an inanimate object.

Newborns can get the infection from infected mothers and children may get one due to sexual abuse.

Trichomoniasis when symptomatic can be strongly suspected, and can be diagnosed by clinical history, and examination.

The diagnosis can be confirmed by observing the discharge under a microscope when the parasites can be seen and easily recognized due to the typical pear shape and presence of few whip like structures called flagellae.

The doctor may ask your personal sexual practices and inspect the genitals. A cotton tipped swab stick may then be used to collect a sample of the discharge which is then laboratory tested. Alternatively, some rapid diagnostic tests may be used. When the microscopic examination is negative yet the infection is strongly suspected, the doctor may subject the samples to culture.

The doctor will also like to determine the pH of the vagina which gives an estimate of the acidic status of the secretions. The normally acidic pH of the vagina may become higher to acquire a more basic nature in trichomoniasis though this is not specific to the infection.

Additionally, your doctor may like to confirm that other STDs like HIV, gonorrhea, or syphilis are not coincidentally present and may advise testing for the same. This is because trichomonisis increases the risk of transmission of other STDs due to the common unsafe sexual practices.

Since men are often symptomless, it is important for men to be screened and evaluated for the infection and your doctor may advise you or your male partner for the same.

Urine may test positive for trichomoniasis in around 60-70% cases.

Trichomoniasis is treatable. All symptomatic and asymptomatic cases and their contacts should be treated.

You may need to take a single dose (2g) of an antibiotic called metronidazole or tinidazole. Alternatively, metronidazole can be taken in a dose of 500 mg twice daily for 5-7 days. These medications tend to interfere with the vital processes in the parasite and ultimately kill them. Cure rates with these are good.

In tougher infections, a repeat course may help. Alternatively, an extended treatment may be advised. Reinfection should be excluded before beginning any extended regimens.

A common side effect of metronidaole or tinodazole can be a bitter taste in mouth. You should also abstain from alcohol for at least 3 days when undergoing trichomoniasis treatment with metronidazole or tinidazole.

Consumption of alcohol when taking these drugs can lead to vomiting, headaches, and flushes.

You may be advised a concomitant local application of gels. Used alone, the results of local therapy are not good but used with oral treatment, the results are encouraging.

You should abstain from sex when undergoing treatment. Your partner also needs to be treated, even if symptom free. You and your partner can resume sex when the treatment is complete and both of you are free of any symptoms.

If you are pregnant, you should ideally avoid taking metronidazole in the early months as it can lead to malformations in the developing baby. However, when the benefits of treatment outweigh the risks, you may be advised to take a 2 g dose. If you breastfeed your baby, you may need to transiently stop breast feeding for a few days when undergoing treatment.

Left untreated, trichomoniasis can spread to the adjacent urinary and other reproductive organs. If not treated well in pregnancy, it can lead to pre-term delivery and low birth weight in the baby and can infect the baby. Trichomoniasis increases the risk of transmission of other STDs like HIV.

If you have once suffered from trichomoniasis, you may be at risk for acquiring the infection for the second time, if safe sex is not practiced.

Immunity to reinfection does not develop after the first episode. The best way to prevent a reinfection is to practice safe sex.

Always use a condom. This will not only prevent a second infection with trichomonas but will also safeguard against spread of other STDs like HIV.

Use a fresh condom every time you have sex. Practice safety in oral sex.

Cover the penis with a condom or vulva with a dam. Avoid sharing vaginal douches or sex toys. Prefer monogamous relations.

Go for regular sexual checkups, especially so if you have multiple sexual partners. Anytime, if tested positive for infection, inform your sexual partners also to undergo treatment.

If you develop any symptoms like profuse discharge or a burning or pain in genitals or notice any local ulcers, abstain from sex and seek medical consultation.

Abstain from sex when on treatment to prevent reinfection. Even if you are on a single dose treatment with metronidazole, you may need to refrain from sex for a week. Treatment reduces spread of infection.