Trichomoniasis

Trichomoniasis symptoms typically include a burning sensation and pain when peeing. In women, the vagina may be red and itchy, and sex can be painful. There might also be a frothy, yellowish-brown discharge that smells foul and unpleasant.

In a lot of people, trichomoniasis doesn't cause any symptoms. In fact, symptoms are more of an exception in men. But even if people don’t have symptoms, they can still pass on the disease during sex.

The infection is caused by trichomonads. These are single-celled parasites that particularly infect the soft tissue lining the urethra (urine tube) and vagina. The medical term for this parasite is “Trichomonas vaginalis.” But the parasites can also cause inflammations of the cervix, the bladder and (more rarely) the rectum.

Trichomonas parasites don't survive very long outside the human body. So people usually only become infected through direct contact with mucous membranes during sex. People who regularly have sex with different sexual partners and don't use a condom have a higher risk of getting trichomoniasis and other sexually transmitted infections.

It is possible to become infected from sharing a bath or through objects like toilet seats and towels, but that is rare. It is also rare for the infection to be passed on from a mother to her baby during birth.

Trichomoniasis infections are one of the most common sexually transmitted infections: It is estimated that about 150 million people are infected each year worldwide. The infection is diagnosed more frequently in women than in men. It is thought to be rare in Germany and similar countries, but there are no clear statistics here.

Trichomoniasis infections often go unnoticed. If people do have symptoms, then these develop about a week after infection on average. Some people already have symptoms after four days, and in others it can take up to three weeks. The infection can become chronic if left untreated – especially in women.

Whether you have symptoms or not, you are contagious for as long as you have the infection.

Complications can occur if the internal sex organs also become infected – such as the lining of the womb (endometrium), the fallopian tubes, or the ovaries in women. If that causes different areas of tissue to become stuck to each other (adhesions), the risk of ectopic pregnancies and infertility increases.

In men, the prostate gland, testicles and epididymis may become infected. This could possibly reduce their fertility.

Women with trichomoniasis have a higher risk of getting HIV because it is easier for the HIV viruses to enter the inflamed mucous membranes.

If a woman has trichomoniasis during pregnancy, that increases the risk of miscarriage or of the child being too small at birth.

The diagnosis involves taking a swab from the inflamed mucous membranes. The doctor will use a cotton bud to take samples of the fluid and mucous membrane cells from the urethra (urine tube), vagina, or possibly the anus. Those samples are examined in a laboratory to look for the parasite.

If the urethra is infected, that can also be diagnosed by taking a urine sample – first thing in the morning, if possible.

It can be helpful to find out how sexually transmitted infections are passed on and what factors increase the risk. Then you can decide whether and which preventive measures are a good idea. You can get information and advice about trichomoniasis and other STIs from sexual health clinics and doctors, such as specialists for dermatology and sexual health.

Condoms and femidoms (condoms for women) are a simple protective measure. But they do not provide complete protection against the parasites.

There is no proof that applying germicidal products to the vagina before sex can prevent trichomoniasis. No other measures are known to prevent it, either.

Prevention also means protecting others: If you have trichomoniasis, it is important not to have sex until you have finished your treatment. The same applies for taking baths together and sharing worn underwear or sex toys. It is also important that you inform everyone who you might have infected. Steady sex partners usually have treatment at the same time to avoid re-infecting each other ("ping-pong effect").

Trichomoniasis can be treated with medication called metronidazole. This antibiotic not only kills bacteria, but also kills single-celled parasites like Trichomonas vaginalis.

The treatment usually only takes one day in men, and seven days in women. The medication has to be prescribed by a doctor. It is taken in the form of tablets, for example in the morning and evening. That is usually enough to effectively kill the parasites.

If the symptoms don't go away, longer treatment might be needed – perhaps combined with metronidazole vaginal suppositories.

Metronidazole has not been approved for use in pregnant women. But experts assume that it doesn't harm unborn babies. If treatment is needed, you can consider taking the medication ‘off-label’ in agreement with your doctor.

The German Federal Institute of Public Health (BIÖG) (previously known as the Federal Centre for Health Education, or BZgA) has a website called liebesleben.de that includes information on STIs like trichomoniasis and practical tips on how to prevent them. They also have an online counseling and telephone advice service.