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When you strip away the social stigma, sexually-transmitted diseases are just infections, not the end of the world. Most are readily curable, and some have no or only minor symptoms. Trichomoniasis is one such infection. Although sexually transmitted, trichomoniasis can be cured with one dose of an antibiotic. Still, like all STDs, it’s crucial to diagnose and treat the infection in a timely fashion.
What is trichomoniasis?
Trichomoniasis is a sexually-transmitted disease that is spread through unprotected vaginal sex with an infected sexual partner. Infecting both and women, trichomoniasis is caused by a parasite, Trichomonas vaginalis (or T. vaginalis), that colonizes the vagina, urethra, and prostate gland. 95% of infections are readily cured by a single large dose of the antibiotic metronidazole.
Trichomonas vaginalis is a protozoan: a one-celled organism. T. vaginalis infection is one of the most common causes of vaginitis in women but over half of women and most men with trichomoniasis experience no symptoms. However, left untreated, trichomoniasis can cause problems in pregnant women—premature membrane rupture, premature birth, and low birth weight. Also, trichomoniasis makes both men and women more susceptible to pelvic inflammatory disease and STDs such as HIV/AIDs, syphilis, and gonorrhea.
Researchers do not know how many people are infected with T. vaginalis. Unlike other STDs, trichomoniasis is not reportable. Also, most people don’t have symptoms and many who do mistake it for a fungal or bacterial infection and treat it at home. One study estimates that approximately 0.5% of women and 1.8% of men in the United States are infected with T. vaginalis, but infection rates are much higher in people who live in inner cities.
Trichomoniasis is frequently mistaken for other conditions, such as fungal or bacterial vaginosis, that may be treatable using over-the-counter topical medications. These medications, however, are ineffective against T. vaginalis, so it is important to see a healthcare provider if symptoms of vaginitis or urethritis (urethral swelling) do not resolve after a few days of home treatment.
How is trichomoniasis diagnosed?
Trichomoniasis infection is diagnosed with a history, physical examination, microscopic examination of vaginal fluid or urine sediment, nucleic acid testing, and, in rare cases, culturing the T. vaginalis parasite from a sample. Most people will be diagnosed and treated by a general practitioner.
Medical History
Medical history will help determine if a patient with mild or no symptoms is at risk for trichomoniasis. T. vaginalis infections are most common in people who have multiple sexual partners. Other risk factors include new sexual partners, unprotected sex, or a history of STD infections. Medical history is also used to identify any sexual partners who may also require treatment.
In your first visit to a healthcare provider or clinic, be prepared to answer questions such as:
- Have you had STDs before?
- Have you had unprotected sex?
- Have you noticed a bad-smelling discharge from the vagina?
The healthcare professional will want to know any symptoms you might have. The symptoms of trichomoniasis closely resemble the symptoms of fungal or bacterial vaginitis or urethritis (swelling of the urethra). They include:
- Bad-smelling and discolored vaginal discharge
- Frequent urination
- Pain during urination
- Pain during sex
Men, however, will typically have no symptoms. When they do, swelling of the urethra or prostate gland will be marked by symptoms including pain during urination and frequent urination. Sometimes, however, the infection reaches the epididymis, a long, coiled tube in the testicles. Epididymitis symptoms include swelling, testicle pain, and painful urination.
Physical examination
A physical examination of the vagina will look for signs of trichomoniasis such as vaginal discharge, odor, swelling, or redness. While “strawberry cervix” is often cited as a common physical symptom, identification will require a colposcopy procedure which is rarely performed during routine exams. Urethritis in men or women usually is not visible in a physical exam, but there may be redness or swelling around the urethra’s opening.
Wet microscopy and pH
Definitive diagnosis will involve taking a vaginal fluid sample, a urethral swab, or a urine sample and noting its pH and examining it under a microscope after mixing it with saline solution. Called wet microscopy, a doctor will be able to quickly and inexpensively identify T. vaginalis microorganisms in about half of patients infected with T. vaginalis. A positive wet microscopy exam is definitive for trichomoniasis.
Nucleic-acid amplification tests (NAAT)
If no T. vaginalis parasites are found in the microscopic exam of a sample, another sample will be tested for genetic material unique to T. vaginalis. Called a nucleic acid amplification test (NAAT), this test can be performed in a healthcare professional’s office or clinic, but sometimes the sample will be sent to a laboratory. If the clinic can perform the test, a diagnosis can be confirmed within the hour.
Culture sample
A sample may be sent to a laboratory to culture the microorganism. A culture is definitive proof of a T. vaginalis infection and can help identify drug-resistant microorganisms. However, it is rarely performed because of cost and delay.
Home testing
A variety of trichomoniasis and STD home tests are available. In all these tests, the patient will send either a swab sample or a urine sample to a laboratory for testing, usually NAAT testing. If the test comes back positive, a healthcare provider may or may not perform these tests a second time before beginning treatment. Because so many people with trichomoniasis are asymptomatic, people at risk for the infection should consider regular home testing.
Trichomoniasis treatment options
Trichomoniasis is usually treated with single-dose metronidazole, but this may vary based on specific circumstances. A follow-up visit will test to confirm the infection has been cleared.
Medications
Treatment of trichomoniasis consists of a single large dose of a nitroimidazole antibiotic, most typically metronidazole. Drug resistance in the parasite may require a different antibiotic, usually tinidazole, and patients with HIV will be put on extended metronidazole treatment.
Drug desensitization
Patients allergic to metronidazole and tinidazole may be referred to an allergist or immunologist who will put the patient on a drug desensitization protocol. Also called induction of drug tolerance, the doctor will give gradually-increasing doses of metronidazole to “trick” the immune system. Drug desensitization is carried out in facilities equipped to handle potentially life-threatening allergic reactions.
Test-of-cure
95% of T. vaginalis infections are successfully cleared by metronidazole or tinidazole treatment. The Centers for Disease Control (CDC) recommends that patients treated for trichomoniasis be seen within three months for a test-of-cure follow-up visit. Most clinics and healthcare professionals will schedule this visit two to three weeks after treatment. A NAAT test will be performed on a vaginal or urethral sample to confirm the infection has cleared.
Expedited Partner Therapy (EPT)
As many as 31% of trichomoniasis patients will experience another T. vaginalis infection often because they continue to have unprotected sexual contact with an infected partner. To prevent recurrent infections and the spread of STDs, most states allow doctors to prescribe medications for the sexual partners of STD patients without seeing or performing a medical exam on the partner. Called Expedited Partner Therapy (EPT), the doctor will give the patient with trichomoniasis a prescription for them and their partner, thus reducing the risk of reinfection.
Trichomoniasis medications
The treatment of choice for trichomoniasis is a single high dose of nitroimidazole antibiotics. However, drug-resistant strains of Trichomonas, patient allergies, and HIV infection may complicate treatment.
Antibiotics
Trichomoniasis is treated with a single, two-gram dose of oral metronidazole, however, your doctor may also consider giving a seven-day course. HIV patients, however, will be given a twice-daily 500 mg dose of metronidazole for seven days. The longer treatment is more successful at eradicating the infection, but side effects are more common. If a significant percentage of the infecting parasite is resistant to metronidazole, trichomoniasis is treated with a single two-gram dose of tinidazole.
What is the best medication for trichomoniasis?
The drugs of choice for trichomoniasis are the nitroimidazole antibiotics metronidazole and tinidazole. The optimal choice will depend on the patient’s allergies to these drugs, the organism’s drug resistance, the presence of HIV infection, and the persistence of the infection.
| Best Medications for Trichomoniasis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Flagyl (metronidazole) | Antibiotic | Oral | Four 500 mg tablets taken in a single dose OR two 500 mg tablets taken twice daily for seven days | Nausea, diarrhea, metallic taste |
| Tindamax (tinidazole) | Antibiotic | Oral | Four 500 mg tablets taken in a single dose taken with food | Metallic taste in the mouth, nausea, fatigue |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health. Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of trichomoniasis medication?
Side effects will vary based on the medication. This is not a complete list, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
Oral nitroimidazole antibiotics typically cause gastrointestinal problems such as an upset stomach, intestinal problems, nausea, and loss of appetite.
Patients who are within the first three months of pregnancy will not be given metronidazole or tinidazole, but the drugs are safe to take during the last two trimesters.
Alcohol should not be ingested within three days of taking a nitroimidazole antibiotic. The reactions, including abdominal cramps, nausea, vomiting, and headaches, can be wildly painful, similar to the effects of drugs, like disulfiram, that are used to help people stop drinking.
The most serious side effects of nitroimidazoles, though rare, include reversible peripheral nerve damage and encephalopathy. Allergic reactions are always a risk with antibiotics. These reactions could be life-threatening, so the physician will need to know the patient’s history of drug reactions.
What is the best home remedy for trichomoniasis?
Trichomoniasis symptoms typically resemble symptoms of fungal or bacterial vaginosis, which many patients treat using over-the-counter topical medications and natural remedies. Home treatment of T. vaginalis, however, is ineffective. Trichomoniasis will require antibiotic treatment to clear the infection and reduce the risk of transmission.
Some individual studies, however, have shown that natural remedies may relieve the symptoms of a T. vaginalis infection or actually clear the infection. These include
None of these studies, however, have been verified, so they should be approached with caution. Still, they may be advised to patients with drug-resistant trichomoniasis that does not respond to nitroimidazole treatment.
As with antibiotic treatment, home treatment will require regular testing by a healthcare professional or using a home testing kit. Natural remedies may eradicate symptoms, but it is uncertain if they can clear the infection. Even if symptoms go away, the patient can still infect their sexual partners.
Frequently asked questions about trichomoniasis
What antibiotics can be used to treat trichomoniasis?
Trichomoniasis is treated by a single two-gram dose of metronidazole or tinidazole. Some patients, though, may receive a seven-day course of metronidazole.
What will happen if trichomoniasis is left untreated?
The patient’s immune system may clear trichomoniasis or reduce symptoms without treatment. However, untreated trichomoniasis can be spread to other sexual partners even without symptoms. Also, untreated trichomoniasis in pregnant women is linked to premature delivery and low birth weight. A T. vaginalis infection also increases the risk of contracting HIV/AIDS and other sexually-transmitted infections. In men, an untreated infection can spread to the prostate gland or epididymis and could lead to infertility.
What does Trichomonas smell like?
In women, trichomoniasis can cause a “fishy” smell in the vagina similar to the odor associated with bacterial vaginosis.
How long does it take for trichomoniasis to go away after treatment?
Trich symptoms usually clear up within a few days after the initiation of antibiotic treatment. Patients will be tested two or three weeks later to verify that the infection is gone.
How can I treat trichomoniasis at home?
Individual studies have shown that some natural remedies such as garlic or pomegranate juice may relieve the symptoms of trichomoniasis or potentially clear the infection (see home remedy section above). Any patient using natural remedies or home treatments for trichomoniasis should be tested for the organism in follow-up visits with a doctor or by using a home testing kit.
Can garlic cure trichomoniasis?
One study showed that a daily garlic capsule tablet was more successful at clearing bacterial vaginosis than metronidazole, but these results have not been verified. T. vaginalis, however, is not bacteria. It is important that any trichomoniasis treatment that relies on or includes natural remedies also include initial testing and a test-of-cure follow-up with a healthcare provider to make sure the infection has been eradicated.
Can trichomoniasis go away on its own?
Left untreated, trichomoniasis may become symptom-free or even be eradicated by the body. Symptom-free patients, however, can still spread the disease to others. Whatever treatment a patient chooses—including no treatment at all—must still include testing to identify if the infection is still present.
Can one partner have trichomoniasis and not the other?
Women or men who have sex exclusively with a single partner can catch any STI that partner may have, including trichomoniasis, if they have unprotected sex. Most men and almost half of women do not show symptoms of a T. vaginalis infection, so the risk of being unknowingly infected with T. vaginalis by a single partner is higher than it is with other STIs.
Is it possible to still have trichomoniasis after treatment?
About 95% of people treated for trich with metronidazole or tinidazole will be completely cured of the infection. Cure rates are higher with concurrent partner treatment. If the infection does not resolve, the patient may require further testing and antibiotic treatment.
Is there a home test for trichomoniasis?
Home trichomoniasis tests allow people to take a vaginal fluid or urine sample which is then sent to a lab for testing. These tests can be purchased as trichomoniasis-only tests or as multiple-STD tests. Results will take two to four days to receive. The cost of the lab test is usually included in the cost of the kit.
Is trichomoniasis a STD?
Trichomoniasis is a sexually-transmitted disease that can only be acquired through unprotected vaginal sex with an infected partner. Trichomoniasis cannot be acquired through oral or anal sex.
Is trichomoniasis the same as chlamydia?
Chlamydia and trichomoniasis are often confused. Both are sexually-transmitted diseases that infect the vagina and urethra. Most people don’t experience symptoms with either infection and, when they do, the symptoms are very similar. However, chlamydia is a bacterial infection that is treated with azithromycin or doxycycline, both of which are ineffective against trichomoniasis. Also, chlamydia can be spread through unprotected vaginal, oral, or anal sex, while trichomoniasis can only be spread through unprotected vaginal sex.