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Trichomoniasis (commonly referred as “Trich”) is a sexually transmitted disease (STD) caused by the parasite, Trichomonas vaginalis. The parasite settles at the urogenital tract and infects sexually active individuals with multiple partners or who fail to use any form of protection. This is the most frequent but curable STD in sexually active young women. Most patients who were diagnosed with gonorrhea and non-gonococcal urethritis were also found to be infected with this disease.

The trich culprit survives in the dark moist regions of the body making the female anatomy a suitable host. Moreover, trichomonas can manage to survive outside the host for many hours increasing risk of transmission even without sexual contact a humid and alkaline environment can contribute to this. It can be sometimes transferred by groin contact with any moist surfaces but for transfer to effectively occur there must be a direct contact of the genital surfaces to the infected area. There are rare incidents where sharing of wet towels or bathing suits had cause the transmission of these parasites. Trichomoniasis in men can also occur but they are often just carriers, exhibiting no perceptible symptoms.

Most of the infected individuals are asymptomatic making it more difficult to control the transmission of the disease. It estimated that around 7.4 million fresh cases worldwide occur every year, affecting both men and women. In the United States, based on CDC reports, about 2 million Americans are infected every year. UK reports roughly 600,000 cases each year. Trich has come across in 5 to 15% of women in gynecology clinics and approximately 50 to 75% in prostitutes around United States.

Menstruation cause women are more susceptible to trichomonas infection. Signs and symptoms would usually appear after 1-3 weeks after transfer but the parasite can be transferred even prior to the appearance of the symptoms. Trichomoniasis in men is seemingly the cause of 7- 10% of urethritis, although identification of the parasite is quite difficult.

The genital squamous epithelium is the primary target sites of T. vaginalis. Incubation period is normally 4 to 28 days but the infection process would take longer in women than in men (10 days or less). Some studies have shown that asymptomatic infections in women may keep on for months or sometimes years. The infection would produce partial immunity only.

Since the history and physical findings are not reliable to correctly diagnose the presence of trichomoniasis, laboratory exams are very important. The problem with this is that the lab tests for this disease are not available in most hospitals and clinics. Surveys have shown that only six of the 100 Public Health laboratories perform the tests for trichomoniasis and those who did perform them; do not have the latest methods for detection.

Symptoms of trichomoniasis are often asymptomatic. An individual who has sexual contact with a partner infected with the disease may manifest the symptoms even just 5 days after the contact although; there have been reported rare cases of a 20-year incubation period. Symptomatic trichomonas infection is more prevalent in women than in men. Trichomoniasis in men is less clinically evident.

Symptoms of Trichomoniasis in Women

The most significant symptoms of trichomoniasis among women are the vaginal itching (mild to severe) with profuse yellowish green vaginal discharges. Other symptoms would include:

• Pain or burning sensation in the vagina
• Strong “fishy” smell
• Epigastric pain
• Dyspareunia (painful sexual intercourse)
• Inflammation in the groin, vagina or cervix
• Polyuria (excessive urination)
• Dysuria (painful urination)
• Dysmenorrhea (painful menstruation)
• Colpitis macularis (strawberry cervix) – the definite sign for trichomoniasis; dispersed or irregular macular erythematous cervical lesions

Trichomoniasis Symptoms in Men

Symptoms of trichomoniasis in men may range from urethritis to none. If symptoms do manifest, they will include:

• Dysuria
• Balanitis (inflammation of the glans penis)
• Balanoposthitis (inflammation of glans penis, prepuce and foreskin)
• Tingling sensation in penis
• Painful ejaculation
• Prostatis
• Polyuria

The most frequent symptom described by men with trichomonas infection is non-gonococcal non-chlamydial urethritis that manifests pruritis at the urethral area, penile discharges and dysuria. Penile discharges may range from mucoid to purulent. Most of these symptoms are self-limiting and intermittent but may cause complications such as epididymitis, prostatitis, infertility and urethral strictures.

Picture 1 :  Trichomonas Vaginalis (Trophozoite)

Image source : women-health-info.com

Picture 2 :  Trichomoniasis (Trich) diseases

Picture 3 :  Trichomoniasis

Image source : wikipedia

Sexually transmitted diseases are any infections transferred by sexual contact from the host to another. Based on the CDC reports, there are more than 15 million STD cases reported in the US each year and that among these diseases, trichomoniasis is one of the most common type being transmitted. Individuals from different age brackets are affected and that amongst the 19 million infections reported each year, most are between ages 15 and 24.

Trichomoniasis is greatly associated with the existence of other STDs such as gonorrhea and Chlamydia. The presence of Trichomoniasis increases the individual’s susceptibility to HIV, herpes and human papillomavirus. The irritation of the epithelial layer would improve the passageway for the HIV to penetrate and the parasite, T. vaginalis, activates the cytokine and T-lymphocytes allowing them to replicate thus increasing the replication of the cells infected with HIV. It would also increase the chances of the development of pelvic inflammatory disease and tubal infertility.

Infected women would have increase probability of delivering preterm infants or develop adverse complications in pregnancy outcomes such as premature rupture of the membranes, intrauterine infection and decreased infant birth weights.

Although trichomoniasis is not a very serious disease, it is very contagious. If left untreated, it could cause infection not only in the urinary tract but also in the reproductive system.

Symptoms experienced by men infected with trichomoniasis are self-limiting and would usually clear up over time but are still considered carriers – capable of transmitting the organisms to their sex partners. Women, on the other hand, need to undergo treatment for trichomoniasis. It would be advisable for both partners to be treated concurrently in order to prevent re-infection. Sexual activities have to be put on hold until treatment plan has been completed.

Treatment for trichomoniasis is usually metronidazole, a nitro-imidazole antibiotic for protozoa and anaerobic bacteria. The standard dose is 400 mg BID for five to seven days. An alternative dosage is to use 2 grams in single dose. The single dose alternative is less effective and could cause additional side effects. Make sure to take the medication with food to prevent irritation of the gastrointestinal tract. Pregnant women are usually not given this medication treatment for trichomoniasis as studies have shown an increased risk in the development of birth defects as the medication can cross the placental barrier – though this is still controversial. There are increasing cases of metronidazole-resistant T. vaginalis and has prompted the search for other medications to treat the disease.

Tinidazole is the second drug of choice and is taken as single dose (2g) only. This drug is normally given to patients who do not respond to the metronidazole therapy. It has a cure rate of 83-100%. Clotrimazole vaginal suppositories were sometimes used to treat the disease but in a study made in 1997 by duBouchet showed a low cure rate (11%).

Preventive measures should also be started to avoid being infected again. Abstaining from sex is the best preventive measure or maintaining a reciprocated monogamous relationship where both partners are not infected. Protected sex is advised for the sexually active individuals – the use of condom could offer some protection.

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