The Call-On-Doc Guide to Trichomoniasis

How trichomoniasis spreads through unprotected sex with an infected partner. The protozoan parasite Trichomonas vaginalis, infects the lower genital tract of women and the urethra of men. Its spread is thus primarily conducted through vaginal coitus with another partner where contact with vaginal fluid is possible. More specifically, male/female and female/female partners are most associated with the spread of trichomoniasis spread while male/male couples are less associated. While there are cases of the parasite infecting the mouth, throat, and anus, such cases are considered rare due to the parasite needing a specific environment. (4)(5)

The importance of getting a trichomonas test when sexually active cannot be understated due to the parasite’s capacity to go dormant for extended periods. Known to remain inactive for months and years, many cases of trich are found when getting yearly tests alongside STDs like chlamydia or gonorrhea. Regardless of whether a patient has symptoms, the STI can still be spread from an infected host to another person, even when dormant. (4)

Another mode of trichomoniasis transmission is through the sharing of sex toys and by hand. While the parasite requires a specific environment to survive, it’s been reported to remain infectious outside the human body for several hours when the object or its environment remains damp. Those regularly sharing sex toys with one or multiple partners should wash them after every sexual activity. When a person’s hands or sex toys are washed and/or remain dry, the parasite dies quickly. (5)(6)

Despite having a limited window of survivability outside the human body, trichomoniasis transmission can occur non-sexually. For example, shared bathroom items like sponges, towels, and the like can be a mode of transmission when shared by multiple people due to the damp environment each item supports. (4)(7) Additionally, it's suspected that shared bathing water is a mode for trichomoniasis transmission in the right conditions. However, such cases are rare and far less likely in clean environments. (8) 

Outside of the bathroom, there are no known modes of trichomoniasis transmission that would infect someone with the parasite. Trich does not last long when in a dry environment or in the presence of soap. Therefore, regular washing of items like towels and sponges, especially if the environment is shared, is recommended. 

Noticeable cases of trichomoniasis in men are uncommon, but those with noticeable cases will feel them manifest in the genitals. When left untreated, the infection can lead to greater susceptibility to other sexually transmitted diseases. 

Trichomoniasis with symptoms is more commonly observed in women due to the specific nature of the infection. The Trichomonas vaginalis parasite primarily infects the urogenital tract in women, leading to noticeable symptoms.

When left untreated, trichomoniasis in women can result in various complications. It can increase the risk of acquiring or transmitting other sexually transmitted infections (STIs), including HIV. Trichomoniasis can also contribute to the development of pelvic inflammatory disease, which is a serious infection of the reproductive organs that can lead to fertility issues, chronic pelvic pain, and ectopic pregnancy. 

Due to it sharing symptoms with other common STDs and STIs, the best method to know whether you have the infection is lab testing. When it comes to how this information is gathered, your healthcare provider will need one of the following:

• Penis or vaginal swab
• Urine sample
• Vaginal fluid sample

It should be noted that sometimes multiple tests can be conducted to remove the possibility of misdiagnosis. The tests take a maximum of a few days but normally come back within hours once they are reviewed by a lab. 

CallonDoc offers both in-person and at-home lab testing for trichomoniasis as well as other STDs. If positive, you can get same-day treatment online and your partner can receive treatment for 50% off. *Note testing is not required for treatment if you have symptoms of an STD.

Alongside questions about the patient’s symptoms, sexual history, and medical history, the most effective trichomoniasis diagnosis method is nucleic acid amplification testing. Considered the gold standard of testing for many STDs and STIs, nucleic acid amplification testing typically involves taking the test at home after it's sent to you, sending it back to a laboratory, and the lab sends you a positive or negative result. (9)

This trichomoniasis test works by extracting the genetic material, specifically DNA, from Trichomonas vaginalis parasites from the urethral swab, vaginal fluid, or urine. The extracted DNA is amplified using techniques like polymerase chain reaction (PCR). The amplified DNA is then detected using various methods, such as fluorescent probes or gel electrophoresis, to confirm the presence of Trichomonas vaginalis DNA.

Trichomoniasis can sometimes be confused with other sexually transmitted infections (STIs) due to overlapping symptoms. The STIs that can be mistaken for trichomoniasis include:

• Bacterial vaginosis: Bacterial vaginosis (BV) and trichomoniasis are two distinct vaginal conditions that share some similarities but have notable differences. BV is characterized by an imbalance in the bacterial composition of the vagina, while trichomoniasis is caused by the Trichomonas vaginalis parasite. In terms of symptoms, BV typically presents with a thin, white or gray discharge with a characteristic "fishy" odor, whereas trichomoniasis is associated with a frothy, yellow-green discharge that may have a strong odor. Additionally, BV is not considered a sexually transmitted infection, while trichomoniasis is primarily transmitted through sexual activity. 
• Yeast infection: Yeast infections (candidiasis) and trichomoniasis are two distinct vaginal conditions with different causes and symptoms. Yeast infections are caused by an overgrowth of Candida yeast in the vagina, leading to symptoms such as intense itching, thick white discharge resembling cottage cheese, and possible redness or swelling. Trichomoniasis, on the other hand, is caused by a parasite and presents with symptoms including frothy, yellow-green vaginal discharge with a strong odor, vaginal itching or irritation, and discomfort during urination or sexual intercourse. 
• Chlamydia and gonorrhea: Chlamydia and gonorrhea are bacterial sexually transmitted infections (STIs) caused by specific bacteria (Chlamydia trachomatis and Neisseria gonorrhoeae), not a parasite. Chlamydia and gonorrhea can infect various body parts beyond the genitals, including the rectum, throat, and eyes, whereas trichomoniasis primarily affects the urogenital tract. Chlamydia and gonorrhea can be asymptomatic or cause symptoms such as abnormal discharge, painful urination, and discomfort during sex. In contrast, trichomoniasis often presents with frothy, yellow-green discharge, vaginal itching, and discomfort during urination or sexual intercourse.

Trichomoniasis can be effectively treated and cured with appropriate medications. The standard treatment for trichomoniasis involves the use of oral antibiotics, most commonly metronidazole or tinidazole. These medications work by targeting and eliminating the Trichomonas vaginalis parasite responsible for the infection.

It is essential to complete the full course of prescribed medication as directed by a healthcare professional, even if symptoms improve or disappear before completing the treatment. This helps ensure that all traces of the parasite are eliminated from the body.

In addition to individual treatment, it is recommended that sexual partners also be evaluated and treated to prevent reinfection or transmission of the infection.

Following the recommended treatment, trichomoniasis typically goes away within a few days to a week. It is important to abstain from sexual activity until both partners have completed treatment and any symptoms have resolved to prevent reinfection. Regular follow-up visits with a healthcare provider may be recommended to confirm the eradication of the infection.

• Metronidazole: Metronidazole works by inhibiting the DNA synthesis process in the Trichomonas vaginalis parasite. Once metronidazole is absorbed into the parasite's cells, it undergoes a chemical reaction that generates toxic byproducts. These byproducts disrupt the parasite's DNA structure, preventing it from replicating and dividing. As a result, the parasite is unable to sustain its life cycle, leading to its death and the elimination of the infection. Metronidazole is specifically active against anaerobic organisms like Trichomonas vaginalis and is considered the drug of choice for trichomoniasis treatment. (10)
• Tinidazole: Tinidazole works in a similar way to metronidazole. It is a nitroimidazole antibiotic that targets the Trichomonas vaginalis parasite. Once inside the parasite's cells, tinidazole is converted into reactive molecules that interfere with the DNA structure and function of the parasite. This disruption hampers the parasite's ability to replicate and survive, ultimately leading to its death and the elimination of the infection. Tinidazole is effective against anaerobic organisms like Trichomonas vaginalis and is an alternative treatment option for trichomoniasis when metronidazole cannot be used or is not effective. (11)

Put simply; you should not attempt an at-home trichomoniasis treatment without antibiotics and instruction from a medical provider. Over-the-counter remedies or home remedies are not proven or effective treatments for trichomoniasis. Home treatment attempts can delay proper diagnosis and lead to potential complications or the spread of the infection. Due to it being a parasite, your body’s normal method of eradicating foreign threats is ineffective. Attempts at home, without the instruction of a medical professional, might help with the symptoms but will not prove to be an effective form of trichomoniasis treatment. 

The most important step to getting rid of the infection is to follow through with the trichomoniasis treatment and abstain from any mode of transmission. It is exceedingly important to inform your partner(s) about the STI, seek treatment, and then testing due to reinfection and furthering the transmission is still a risk. Once the antibiotics are through, it is best to abstain from sexual activity until you get the final test specifically for trichomoniasis conducted and find it to be negative, also known as a “test of cure.”. For maintaining a healthy sex life it's important to get regularly tested and treated for STDs and practice safe sex habits such as: using condoms, limiting the number of sexual partners, having open communication with your partner(s) and getting regular checkups.

1. “STD Facts - Trichomoniasis.” CDC, https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm.
2. Flagg, Elaine W et al. “Prevalence of Trichomonas vaginalis Among Civilian, Noninstitutionalized Male and Female Population Aged 14 to 59 Years: United States, 2013 to 2016.” Sexually transmitted diseases vol. 46,10 (2019), December 20, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924265/. 
3. Hearn, Lauren E et al. “Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs.” Substance use & misuse vol. 50,12 (2015), January 3, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941433/. 
4. “What Is Trichomoniasis? & How Do You Get It?” Planned Parenthood, https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/trichomoniasis.
5. Ryan, Christopher M et al. “Trichomonas vaginalis: current understanding of host-parasite interactions.” Essays in biochemistry vol. 51 (2011), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445371/. 
6. “LA County Department of Public Health.” LA County Department of Public Health, http://publichealth.lacounty.gov/dhsp/Trich.htm.
7. Kandamuthan, Subitha et al. “Trichomoniasis: Is it always sexually transmitted?.” Indian Journal of sexually transmitted diseases and AIDS vol. 35,2 (2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553853/. 
8. Crucitti, Tania et al. “Non-sexual transmission of Trichomonas vaginalis in adolescent girls attending school in Ndola, Zambia.” PloS one vol. 6,1 e16310. 31 Jan. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031561/. 
9. “Trichomoniasis - Diagnosis & treatment.” Mayo Clinic, 17 May 2022, https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613.
10. Kissinger, Patricia et al. “Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial.” The Lancet. Infectious diseases vol. 18,11 (2018), https://pubmed.ncbi.nlm.nih.gov/30297322/. 
11. “Tinidazole (Tindamax) for Trichomoniasis and Bacterial Vaginosis.” aafp, American Family Physician, 15 Jan 2009, https://www.aafp.org/pubs/afp/issues/2009/0115/p102.html.