Topic Overview
What is trichomoniasis?
Trichomoniasis is an
infection with a tiny parasite spread by sexual contact (sexually transmitted infection (STI)). It is sometimes
called a Trichomonas infection or trich (say "trick").
Both men
and women can get a trich infection, but it is more commonly detected in women. Trich in
pregnant women can cause problems with the pregnancy.
What causes trich?
Trich is caused by a one-cell
parasite.
- In women, the parasite usually infects the
vagina and cervix,
urethra and
bladder, and glands in the genital area.
- In men, the parasite infects the
urethra or under the foreskin of the penis if it isn't circumcised.
What are the symptoms?
Many women and most men do
not have any symptoms of trich. But when you do have symptoms, they usually
start within 1 week after you were infected.
In women, symptoms include:
- Changes in your vaginal discharge. You may notice a color or
odor that isn't normal.
- Vaginal itching.
- Pain during urination or sex.
In men, symptoms include:
- An abnormal discharge from the penis.
- Irritation of the tip of the penis.
- A burning feeling when you urinate.
The time from contact with the trich parasite until you
get symptoms can range from 5 to 28 days.footnote 1 This is
called the
incubation period. You can spread trich to others
during this time and until you finish the prescribed medicine. You should avoid
all sexual contact until you finish taking your medicine and the symptoms are
gone.
How is trich diagnosed?
Your doctor can tell if
you have trich by asking about your past health and doing a physical exam. He
or she may order lab tests to find the parasite that causes trich. In women,
the parasite may sometimes be found during a routine
Pap test. This test is done as part of a
pelvic exam.
How is it treated?
Your doctor will prescribe
medicine called metronidazole or tinidazole to treat trich. These kill the
parasite that causes the infection. The medicine is usually taken by mouth as
pills, tablets, or capsules. Medicine given in the vagina will not cure
trich.
It is important to treat trich. Treatment can:
- Kill the parasite and get rid of the infection and the
symptoms.
- Prevent you from spreading trich to others. Make sure that
your sex partner(s) will be treated at the same time that you get treatment so
that you don't get infected again. Avoid all sexual contact until you finish
taking the medicine and until your symptoms are gone.
- Reduce the risk of pelvic infections. These may lead to women
not being able to get pregnant (infertility). Trich can also lead to
infertility in men.
- Reduce the risk of infection after any pelvic surgery.
- Reduce the risk of getting other STIs, especially
HIV.
How is trich spread, and how can it be prevented?
Trich is spread when a person has unprotected sex with an infected
partner. Some people carry the parasite that causes trich, but they do not have
symptoms. So it is important to practice safer sex to prevent getting trich.
Using a condom each time you have sex may reduce your chance of getting an
STI.
In rare cases, it may be possible to get trich from contact
with personal items, such as a wet towel, that a person with trich has just
used. The trich parasite cannot live on objects for long, so it isn't usually
spread this way.
Trich may be spread from a mother to her baby
during a vaginal delivery, but this is also rare.
Symptoms of a
trich infection in young children may be a sign of sexual abuse. They need to
be checked by a doctor.
Frequently Asked Questions
Learning about trichomoniasis: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Cause
Trichomoniasis (trich) is caused by a
tiny
parasite (a one-celled protozoan) that most commonly
is sexually transmitted from an infected person.
In
women, trich organisms usually infect the vagina and cervix,
urethra,
bladder, and glands in the genital area, such as the
Bartholin's and Skene's glands.
In men,
infections develop in the urethra or under the foreskin of an uncircumcised
penis.
Symptoms
Many women and men infected with
trichomoniasis (trich) do not have symptoms. If symptoms develop, they usually appear within 1 week after a person is infected. But symptoms can develop months later.
In women
Symptoms may be worse during pregnancy
or right before or after a menstrual period. Symptoms in women may
include:
- Large amounts of pale yellow or gray-green, sometimes foamy
discharge from the vagina.
- Vaginal itching or irritation.
- Abnormal musty or fishy odor.
- Pain with sexual intercourse even if you use a lubricant such
as K-Y Jelly or Astroglide.
- Patchy red areas on the genitals or on the cervix (strawberry
cervix).
- Painful urination (dysuria) or frequent urination.
- Discomfort in the lower abdomen. This isn't a common symptom
of trich, and it may mean another problem is present.
In men
Men rarely have symptoms but still need
treatment. If symptoms are present, they may include:
- Abnormal discharge from the penis.
- A burning feeling after urination.
- Irritation and redness of the tip of the penis.
Trich can have symptoms similar to those of other
sexually transmitted infections such as
gonorrhea or
chlamydia.
What Happens
Trichomoniasis
(trich) infection is spread when you have unprotected sex with an infected partner.
Many women and most men do not have any symptoms of trich. If symptoms appear,
they usually start within 1 week after a person is infected. But it may take up to a month for symptoms to appear. In most cases, trich should be treated to prevent
transmitting this sexually transmitted infection (STI) to others and to prevent some problems that can happen if
you are pregnant. You and your sex partner(s) should be treated for trich at
the same time, to avoid reinfecting each other.
Trich during pregnancy raises the risk of premature rupture of membranes
(PROM) and premature delivery. Treating the infection may not always reduce this risk, but it can relieve symptoms and prevent infection in the newborn. If you are pregnant and have trich, talk
to your doctor about the pros and cons of treatment.
Trich may be
transmitted from a mother to her baby during a vaginal delivery, but this is
rare.
What Increases Your Risk
Behaviors that will increase your risk of
getting trichomoniasis (trich) include:
- Not using condoms when having sex with a new partner or a partner
who may have been exposed to a
sexually transmitted infection (STI). It is possible for
a partner to transmit the trich
parasite without having any symptoms of the
infection.
- Having many sex partners, which increases your risk of being
exposed to someone who has trich.
Teenagers and young adults are at higher risk for
getting trich and other STIs, because their sex partners often have had other
recent partners who may carry an STI.
You can get other STIs, such as
gonorrhea,
chlamydia,
HIV, and
syphilis, at the same time you get a trich infection.
If one STI is diagnosed, testing for other STIs should be done so that all
infections can be treated at the same time.
Some infections that
can be spread through sexual contact, such as the
human immunodeficiency virus (HIV) infection, are
life-threatening. Studies show that trich infection may increase the risk of
transmitting HIV infection.footnote 1 Health professionals
around the world are concerned about the increased risk of trichomoniasis and
HIV.
Women who have trich may also be at risk for other vaginal
infections such as yeast infections or
bacterial vaginosis.
When To Call a Doctor
Call your doctor immediately if you:
- Have lower belly pain and a fever higher than
101°F (38.3°C) along with an
abnormal vaginal discharge.
- Are pregnant and have symptoms of a
vaginal infection or a
urinary tract infection (UTI), such as abnormal discharge from the vagina or pain or burning during urination.
Call your doctor for an appointment within 1
week if you:
- Have an abnormal vaginal discharge.
- Have unusual vaginal itching.
- Have pain during sex or urination.
- Find out that your sex partner has been diagnosed with or treated
for
trichomoniasis (trich).
Watchful waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition
without using medical treatment. Watchful waiting isn't appropriate if you
think you have trichomoniasis (trich). In most cases, trich should be treated
to prevent transmitting this sexually transmitted infection to others and to
prevent some problems that can happen if you are pregnant.
Note: Trich during pregnancy raises the risk of premature
rupture of membranes (PROM) and premature delivery. Treating the infection may not always reduce this risk, but it can relieve symptoms and prevent infection in the newborn. If you are pregnant
and have trich, talk to your doctor about the pros and cons of
treatment.
Who to see
Health professionals who can diagnose and treat a
trichomoniasis (trich) infection include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Trichomoniasis
(trich) is diagnosed by using:
- Your medical history, which will include questions about your
sexual history and practices.
- A physical exam.
- For women, this will include a visual
exam of the genitals, vagina, or cervix to detect patchy red spots that are
caused by trich. Any vaginal discharge will be assessed for color, odor, and
texture. A sample of discharge is taken for a wet mount test.
- For men, this will include a visual
exam of the penis and a sample of discharge from the
urethra or a urine sample.
- Tests to identify the trich organism.
- Wet mount, a microscopic evaluation of fluid from the
vagina.
- Culture.
- Antigen detection test (immunochromatographic strip test)
that detects trich.
- Amplified DNA probe test, which detects genetic material (DNA) of the trich
parasite.
People can get other
sexually transmitted infections (STIs), such as
gonorrhea or
syphilis, at the same time they get a trich infection.
If one STI is diagnosed, you will likely be tested for other STIs so that all
infections can be treated at the same time.
In women, the trich
parasite may also be identified by a routine
Pap test done as part of a regular gynecologic exam.
Expert opinions vary on the accuracy of a Pap test for diagnosing trich. But if
a Pap test shows trich, your doctor will probably talk to you about treatment
or maybe other tests.
Treatment Overview
Trichomoniasis
(trich) is treated with an oral
antiprotozoal medicine, such as metronidazole or
tinidazole. The medicine is taken either as a single dose or as
multiple doses.
Your sex
partner(s) should be treated at the same time you are being treated. This increases
the cure rate and reduces the possibility of further transmission or
reinfection. Sexual intercourse should be avoided during treatment until
symptoms are gone and until partners have been treated. It is
best to avoid sex for 1 week after treatment with a single dose of
metronidazole. Male partners may not have symptoms but still need
treatment.
People who are infected with
HIV receive the same treatment for trich as those who
are HIV-negative.
Trichomoniasis in pregnant women
Trichomoniasis
during pregnancy raises the risk of
premature rupture of membranes (PROM) and premature
delivery. Treating the infection may not always reduce this risk, but it can relieve symptoms and prevent infection in the newborn. If you are pregnant and have trichomoniasis, talk to your
doctor about the pros and cons of treatment.
Vaginal
suppositories and creams aren't effective in curing
trich, but they may reduce discomfort and swelling in the genital area.
Follow-up
- No follow-up is needed if symptoms go away. It is possible to
get trich again, so it is important to take measures to reduce your risk for
trich and other sexually transmitted infections (STIs).
- If symptoms do not go away, you may need to take the medicine
again.
- If treatment fails after this and you have not been
reinfected, further testing may be done to find out the cause of your
symptoms. It is possible to have a strain of trich that is resistant to
antiprotozoal medicines. High-dose tinidazole may be used for
metronidazole-resistant trich organisms and is as effective as metronidazole in
curing trich.footnote 1
If trich goes untreated or isn't properly treated,
complications can develop, such as
pelvic inflammatory disease (PID) in women or
conditions that contribute to
infertility in men.footnote 2
Prevention
Take measures to reduce your risk of
becoming infected with
trichomoniasis (trich) or other
sexually transmitted infections (STIs), such as
gonorrhea,
chlamydia,
HIV, or
syphilis. You can also reduce the risk of transmitting
an STI to your sex partner(s).
Practice safer sex
Preventing an STI is easier than
treating an infection after it occurs.
- Talk with your partner about STIs before beginning a sexual
relationship. Find out if he or she is at risk for an STI. Remember that it is
quite possible to be infected with an STI without knowing it. It can take up to
6 months before some STIs, such as HIV, are detected in the blood.
- Be responsible.
- Avoid sexual contact if you have symptoms of an STI or are
being treated for an STI.
- Avoid all intimate sexual contact with anyone who has
symptoms of an STI.
- Don't have more than one sex partner at a time. Your risk of
getting an STI increases if you have several sex partners at the same
time.
Male condom use
Using condoms may reduce the risk of
becoming infected with an STI. Condoms must be put on before beginning any
sexual contact. Use condoms with a new partner until you are certain he or she
does not have an STI. It is important that
you use a condom properly to prevent the risk of trich infection.
Female condom use
Even if you are using a birth
control method to prevent pregnancy, you may wish to use female condoms to reduce your
risk of getting an STI.
Home Treatment
There is no home treatment for
trichomoniasis (trich). But you can lower your chances
of getting trich or other
sexually transmitted infections (STIs) by making careful
choices about sex. For example, you can make sure to always use condoms during
sex. For more information, see the topic
Safer Sex.
Trich is not usually
transmitted by contact with objects. But avoid using objects
such as washcloths or wet towels that a person with trich may have used.
It is safe for a woman to use tampons while she has a trich infection,
but it may be uncomfortable.
Avoid douching. It does not help
relieve symptoms, and it can even make them worse.
Medications
Trichomoniasis
(trich) is usually treated with a medicine called metronidazole.
Tinidazole has been shown to be useful too.
Medicine choices
Antiprotozoals, such as metronidazole or tinidazole,
are medicines that kill the tiny
parasite that causes trich.
What to think about
Metronidazole vaginal
medicines aren't recommended, because
oral metronidazole works better.
Other Places To Get Help
Organizations
American Sexual Health Association
www.ashastd.org
Centers for Disease Control and Prevention (CDC): National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.)
www.cdc.gov/nchstp
References
Citations
- American Academy of Pediatrics (2015). Trichomonas vaginalis infections. In DW Kimberlin et al., eds., Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed., pp. 798-800. Elk Grove Village, IL: American Academy of Pediatrics.
- Hobbs MM, et al. (2008). Trichomonas vaginalis and trichomoniasis. In KK Holmes et al., eds., Sexually Transmitted Diseases, 4th ed., pp. 771-793. New York: McGraw-Hill.
Other Works Consulted
- McCormack WM, Augenbraun MH (2015). Vulvovaginitis and cervicitis. In JE Bennett et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed., vol. 1, pp. 1358-1371. Philadelphia: Saunders.
Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerJeanne Marrazzo, MD, MPH - Infectious Disease
Current as ofApril 4, 2017