Tricomoniasis

TREATMENTS OF SEXUALLY TRANSMITTED DISEASES

Trichomoniasis

This disease can affect not only the external genitalia, but also the internal urogenital system, as a consequence of insufficient or delayed treatment.

Trichomoniasis

Table of Contents

Definition

What is trichomoniasis?

Trichomoniasis is an infectious disease caused by a parasite called trichomonas vaginalis. In women, trichomoniasis causes vaginal discharge with a bad odour, itching, and burning when urinating. In pregnant women, trichomoniasis may increase the chance of preterm labour. Men infected with trichomoniasis usually have no symptoms, although it is possible as we will see.

Trichomonas vaginalis is transmitted by genital contact, during vaginal or anal intercourse, without protection by barrier methods (such as latex condoms). This disease can affect not only the external genitals but also the internal urogenital apparatus, as a result of insufficient or late treatment. In some cases, co-infection with gonorrhoea or other sexually transmitted infections may occur, worsening the patient’s clinical condition.

Although almost one in five patients infected with trichomonas vaginalis relapses within three months or less of the start of treatment, it’s considered to be the most common curable sexually transmitted infection.

Treatment for trichomoniasis usually consists of antibiotic drugs such as metronidazole or tinidazole.

FRequent causes

what causes it?

Trichomoniasis is caused by a tiny intracellular parasite called trichomonas vaginalis, which is sexually transmitted, by contact with mucous membranes.

The time from infection and the development of signs and symptoms of the disease is about three weeks. This increases the risk of infecting other people during this period.

The male genitourinary tract is the only natural reservoir of this parasite, so there is no likelihood of contracting this disease from the environment.

How does the microorganism work?

Trichomoniasis is caused by a tiny intracellular parasite called trichomonas vaginalis, which is sexually transmitted, by contact with mucous membranes.

 

The time from infection and the development of signs and symptoms of the disease is about three weeks. This increases the risk of infecting other people during this period.

 

The male genitourinary tract is the only natural reservoir of this parasite, so there is no likelihood of contracting this disease from the environment.

How is it transmitted?

This sexually transmitted infection (STI) is transmitted through direct contact of the genital mucous membranes during vaginal, anal or oral sex, even when symptoms have not started to occur in the patient.

 

The body area most predisposed to acquiring the parasite is the lower part of the female genitals (vagina, vulva, and urethra) in women and the urethra in men. Because the parasite needs a human cell to feed and survive, there is no risk of getting the disease in swimming pools, public restrooms, or by sharing towels or used clothing.

 

Transmission can occur from the penis to the vagina or vice versa.

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symptomatology

What are its symptoms?

At least in female patients, the course of the disease begins with an asymptomatic period, in which there is no vaginal discomfort and the parasite is in active proliferation.

When the number of parasites increases and they begin to attack the mucous membrane of the genitals, there are symptoms like the following (in women):

Persistent pain and itching.
Persistent pain and itching.

Burning during urination or intercourse.
Burning during urination or intercourse.

Foul-smelling vaginal discharge (in women).
Foul-smelling vaginal discharge (in women).

Swelling and redness of the labia and vulva.
Swelling and redness of the labia and vulva.

In men, trichomoniasis often goes unnoticed for even weeks. The most obvious symptoms (if present) are urethritis (inflammation of the urethra and burning when urinating) and the presence of constant mucus or purulent secretion.

If the infection is not stopped in time, the clinical condition can be complicated by prostatitis and epididymitis, pathologies that are difficult to treat.

Can a contagion be asymptomatic?

Infection could indeed be asymptomatic in men and women. However, in men it’s much more frequent. More than 70 per cent of people with trichomonas vaginalis have no symptoms, while the infection remains latent.

Differences between men and women

In countries like Spain, trichomoniasis is almost twice as common in women as in men, because the female anatomy offers a better microenvironment for the parasite to reproduce and cause disease.

In men, the urethra is much less wide and the flow of urine can drag parasites out during urination or ejaculation.

Medical evaluation

Risk factors

Factors such as the following may increase the risk of getting the parasite and developing the disease:

How to prevent it?

Trichomoniasis can be prevented by using condoms when having sex with a partner, who should be trusted (without the risk of suffering from any STD).

When you start having sex with a new partner who has been very promiscuous in the past, it’s not unreasonable to start by testing for sexually transmitted infections in case of doubt.

Genital hygiene (in both women and men) is also essential. For example, wearing underwear that allows the area to be dry and moderate use of douches also helps.

Diagnosis

How is it diagnosed?

The clinical condition of the disease (examination in person) and the patient’s history and sexual habits should be enough for the doctor to confirm a case of trichomoniasis and apply treatment.

Other specialized tests have a higher level of reliability, especially in patients with confusing signs and symptoms. These tests include microscopic examination of vaginal (or urethral secretions in men), rapid tests with test strips, and amplification of nucleic acids (PCR, quite specific but expensive).

During routine Pap smears, to test for cervical cancer, trichomoniasis may be observed.

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Technique and treatment

How to treat the disease

In more than 95 per cent of cases, one dose of metronidazole is enough to kill trichomonas vaginalis in women. However, precautions should be taken with possible pregnancies, as this drug may slow fetal growth if given during the first trimester of gestation.

This treatment should be applied to the patient with trichomoniasis and the patient who appears healthy (or has not begun to develop symptoms) to ensure that the disease is eliminated.

Also, certain topical preparations with metronidazole or imidazole have shown to be quite effective in treating trichomoniasis in combination with oral treatment. By themselves, these topical medications are not as effective because the Skene glands (in the vaginal canal) function as a reservoir site, into which such medications would be difficult to enter.

In men, trichomoniasis is usually fought off by the immune system without the need for medication. But it’s important that during this period there is constant monitoring of the infection and that appropriate measures are taken to prevent the transmission to healthy people.

¿Existen re-infecciones luego de haber recibido tratamiento? ¿hasta qué momento sigue siendo transmisible?

Re-infections with trichomonas vaginalis are quite frequent (more than half of the cases treated suffer recurrences of the disease). However, the prognosis is encouraging. With an adequate treatment for a new appearance of this STD, the disease can be eliminated without leaving sequels.

However, calculating the exact time of the trichomoniasis infection remains a complicated task for the simple reason that trichomonas vaginalis can remain latent for some time without causing symptoms.

Latex condoms should be used at least four months after infection with trichomonas vaginalis.

Frequent questions

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Can there be complications?

Although rare, complications from trichomoniasis can occur in patients with special conditions. For example, in gestational women, the disease could advance the time of labour from weeks to months, most likely due to the weakening of the vaginal mucosa and the constant immune reaction in that area, which activates pro-inflammatory substances such as cytokines.

In turn, this disease has been shown to increase the risk of contracting HIV and other sexually transmitted infections.

In men, urethritis and prostatitis caused by infection with trichomonas vaginalis are highly likely to become malignant over time, increasing the risk of developing prostate cancer.

What patients are most at risk for complications?

Patients at higher risk of complications from initial infection with trichomonas vaginalis are those whose immune systems have been weakened by more chronic conditions. For example, seropositive patients (HIV), patients with systemic lupus erythematosus (SLE), inadequately controlled diabetics, morbidly obese, sex workers, or patients with cancer and antineoplastic treatments (chemotherapy), as the latter decrease the body’s immune response.

For a couple of weeks i have had mucous secretions through the urethra, do i suffer from trichomoniasis?

The causes of mucous secretions from the urethra are quite extensive, ranging from vaginal infections by bacteria to increased cervical mucus during ovulation. Only through specific tests (such as microscopic observation, test strips for trichomonas vaginalis or PCR) a case of real trichomoniasis can be confirmed to start treatment. However, this vaginal discharge has a particular characteristic, an unpleasant or infrequent odour.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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