Trichomoniasis (or “trich”) is a very common sexually transmitted disease (STD). It is the most common curable and non-viral STD. In the United States, CDC estimates that there were more than two million Trichomoniasis infections in 2018. There was also an estimated 276.4 million cases in 2008 and nearly 90 % of these infections occurred among people living in resource-limited settings. Infection is more common in women than in men. Older women are more likely than younger women to have been infected with Trichomoniasis.
What causes Trichomoniasis
It is caused by infection with a protozoan parasite called Trichomonas vaginalis. This parasite is a very tiny microorganism which cannot be seen with the naked eye.
The parasite passes from an infected person to an uninfected person during unprotected sex. In women, the most commonly infected part of the body is the lower genital tract made up of the vulva, vagina, cervix, or urethra. In men, the most commonly infected body part is the part of the urethra which passes through the penis, the tip of the penis can also be infected. During sex, the parasite usually spreads from a penis to a vagina, or from a vagina to a penis, but not from a penis to another penis. It can also spread from a vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus. The parasite can also spread through the sharing of sex toys of an infected person without properly washing them or covering them with condoms.
What are the signs and symptoms of Trichomoniasis?
Out of those who contact the disease, more than 70% do not develop symptoms at all, so it will be asymptomatic in such people. Factors like overall immunity or prior health status of the individual, the vaginal pH may contribute to who develops the disease and who does not. The symptoms usually manifest within one month of contracting the disease.
In women, they include:
Abnormal vaginal discharge that may be clear, thick, thin, frothy, green, yellow, gray and yellow-green in colour. This discharge can be copious, with a bad or unpleasant fishy smell. There may also be blood in the vaginal discharge
There is often soreness, swelling and itching around the vagina and the inner thighs sometimes.
There is pain, discomfort or burning sensation when urinating or having sex.
It has also been implicated in adverse pregnancy outcomes like pre-term delivery and low birth weight in pregnant women with the disease.
The symptoms of trichomoniasis are often worse in women during menstruation, probably because the vaginal pH is not as acidic during this period and menstrual blood serves as a rich medium for the organism to multiply. Practices like that increases the vaginal pH or reduces the acidity of the vagina like douching, use of certain antiseptic soaps, unwashed semen in the vagina all predispose to worsening symptoms or flares of the disease.
In men, the symptoms include:
Itching or irritation inside the penis;
Burning after urination or ejaculation; and
Discharge from the penis.
Treatment of Trichomoniasis
Unlike in men, where the disease can resolve spontaneously, T. vaginalis infection can persist for long periods in the female urogenital tract. Up to one-third of asymptomatic women will develop symptomatic infection within 6 months.
Topical vaginal medications (creams and gels) and pessaries can be prescribed for the treatment of T. vaginalis in women. Modern preparations include clotrimazole, and povidone-iodine. These provide local symptom relief, but are not curative. There are no topical treatments for trichomoniasis in men
The only curative treatment currently available for T. vaginalis infection in the United States is metronidazole. This is prescribed by the doctor.
Reasons why Trichomoniasis won’t go away
Despite the effectiveness of the medication for treatment of the disease, about 1 in 5 people get infected again within 3 months after receiving treatment. This makes the disease somewhat tricky as some people are concerned the disease is not going away. Unlike some other diseases, the body does not develop immunity to Trichomoniasis after infection or treatment so the same person can be infected as many times as possible.
Firstly, a treated person can be easily re-infected after getting treated for the disease by an infected partner, hence it is usually advisable to test and treat both infected person and partners even if asymptomatic. This is true particularly for male partners because they often do not show symptoms and also for people with multiple sexual partners.
Also, there may be treatment failure or resistance. This may result if the person does not take the adequate dose of the drug or misses a dose. Even though metronidazole is very effective in curing Trichomoniasis, research has have shown that about 5% of cases of Trichomoniasis are caused by resistant strains of the parasite.
Apart from resistance to the disease, about 7–10 % of people who are adequately treated with metronidazole do not achieve cure. The reason for this is still being debated but may be related to the immunity of the individual.
What to do if your symptoms of Trichomoniasis keeps coming back
If you keep on having this disease after treatment or your symptoms will not go away, do consult your doctor to identify the cause. You and your partner may have to get tested again for the disease. Also if your partner is re-infected by another person, he/she may infect you again. It is better to have safe sex with condoms to avoid this. It is also advised to abstain from sex while being treated to avoid recurrence.
You may also have to review your vaginal hygiene practices especially during your menstruation to know if you are unknowingly increasing the pH of your vagina, making yourself predisposed to infection.
If no other cause can be traced, your doctor may increase the dose of your medication, or switch to tinidazole, which is a more expensive alternative drug for the treatment of this disease.