Brief overview
- Symptoms: Not always present. Greenish, unpleasant smelling vaginal discharge, burning sensation when urinating, itching, pain during sexual intercourse, possibly discharge from the male urethra
- Treatment: Antibiotics from the nitroimidazole group (usually metronidazole)
- Causes and risk factors: Single-cell pathogen Trichomonas vaginalis, sexually transmitted disease, infection through unprotected sexual contact, rarely during childbirth
- Examination and diagnosis: Gynecological or urological examination, pathogen detection from smear, microscopic detection, pathogen cultivation, PCR test
- Course of the disease and prognosis: Completely curable with appropriate treatment. Re-infection is possible.
- Prevention: Protected sexual intercourse (condoms), partner treatment to prevent re-infection
What is a trichomoniasis infection?
Trichomoniasis or trichomonas infection is an infection with the pathogen Trichomonas vaginalis. This is a parasite that belongs to the protozoa. Protozoa are unicellular organisms. Examples of other protozoa are the malaria pathogens and the toxoplasmosis pathogens. Trichomonas vaginalis has a pear-like shape and carries thread-like structures on its surface that are used for locomotion.
Apart from humans, Trichomonas vaginalis has no other reservoir where it can survive for long. Outside the human body, the parasite usually dies quickly – the exception being moist objects and water. However, contaminated water is of no great significance from an epidemiological point of view.
The infestation with Trichomonas vaginalis is largely based on estimates, as the disease is not notifiable. Experts assume that 120 million people worldwide are infected with Trichomonas every year. It is one of the most common sexually transmitted diseases. Trichomonas vaginalis spreads quickly due to the frequent absence of symptoms in those infected.
Alongside bacterial vaginosis and fungal infection (candidiasis) of the female genital tract, trichomonas infection is one of the most common causes of complaints in the vaginal area (vagina). It is important that a trichomonas infection is detected and treated at an early stage.
If left untreated, the infection can lead to complications during pregnancy. In addition, an existing trichomonas infection facilitates infection with other sexually transmitted diseases. Therefore, several sexually transmitted diseases often exist at the same time.
How does a trichomonas infection manifest itself?
Vaginal discharge is one of the most common symptoms of a Trichomonas vaginalis infection. The discharge is often foul-smelling, green and foamy. In addition, sexual intercourse is often painful. Non-specific abdominal complaints are also possible with a trichomonas infection.
Trichomonads in men rarely cause symptoms. The signs are non-specific and manifest themselves as discomfort when urinating and urethral pain. Sometimes there is also a slight discharge from the urethra. In rare cases, the glans is inflamed. The intensity and severity are usually much less than in women.
It is also advisable for men to consider a trichomonas infection if they have corresponding symptoms.
How is a trichomonas infection treated?
Standard therapy
Antibiotics from the nitroimidazole group are used to treat a proven trichomonas infection. A single dose of 2 grams of the antibiotic metronidazole is almost always sufficient.
If this does not help, the doctor adjusts the dose and duration of treatment (usually 500 milligrams of metronidazole twice a day for seven days). If this is still not enough, the doctor will increase the dose to 2 grams of metronidazole daily for seven days.
Local administration of metronidazole in the form of a gel is not recommended, as glands or other areas that are not accessible to local therapy are often affected. Until trichomonas therapy has been completed, those affected should remain sexually abstinent, i.e. not have sexual intercourse.
There is a high probability of successful recovery if these treatment suggestions are followed. In up to 20 percent of cases, spontaneous recovery is possible without trichomoniasis therapy. Alcohol should not be consumed during treatment – this applies up to 48 hours after taking the last tablet.
Treatment of the partner
Often the reason for a new infection is not necessarily a failure of the therapy, but a re-infection by the partner. Therefore, if a trichomonas infection is detected, the partner should always be treated as well. The partner receives the same treatment as the affected person.
Treatment during pregnancy
The doctor should not use metronidazole in an existing pregnancy without careful consideration. Especially in the first trimester of pregnancy, the doctor carefully weighs up the application. There are a number of studies on the use of metronidazole, most of which give no indication of any negative consequences of therapy for pregnant women.
What are the causes and risk factors for a trichomonas infection?
Trichomonas infection is one of the so-called sexually transmitted diseases (STDs). This means that in almost all cases, infection with trichomonads occurs during sexual intercourse. This means that the infection is usually limited to the vagina and the lower urinary tract.
However, trichomonads are also transmitted through contact with infectious bodily fluids, for example during petting or through shared towels. As the majority of infected people do not show any symptoms, transmission often occurs unknowingly.
When Trichomonas vaginalis attaches to body cells, the pathogen triggers an inflammatory reaction. The protozoa excrete soluble substances that damage the cells.
During childbirth, there is a risk that an infected mother will transmit the trichomonas infection to her child. However, this only happens in two to 17 percent of cases.
Infection of prepubertal girls is rare. If an infection with Trichomonas occurs in a child, this is a possible indication of sexual abuse.
Risk factors
Statistically, trichomonas infections are more common in people with a low socio-economic status, changing sexual partners and poor hygiene. People affected by other sexually transmitted diseases often also have an existing trichomonas infection. Conversely, trichomoniasis makes people more susceptible to HIV infection.
How does the doctor diagnose a trichomoniasis infection?
The specialists for a trichomoniasis infection are a gynecologist or urologist. During the initial examination, the doctor will ask the following questions, among others:
- Do you have any known infections of the urogenital area?
- Have you noticed unusual discharge from the vagina/penis?
- Do you have pain when urinating or during sexual intercourse?
- Have you recently had frequently changing sexual partners?
At the beginning, the genitals and, if possible, the urinary tract are examined. Swelling, redness and other signs of inflammation are the first indications of an existing infection. A detailed examination of the female genitals by colposcopy, using a special microscope, reveals further signs of inflammation and irritation. In up to 15 percent of infected women, the examination is inconspicuous.
Trichomonads can also be stained for examination under the microscope, but this requires experience. However, the best way to detect the infection is to cultivate the trichomonads from secretions or urine. There is also a molecular biological method (PCR) that can be used to detect the DNA of the pathogen.
If trichomoniasis is diagnosed, it is advisable to check for other existing sexually transmitted diseases at the same time, especially HIV. It is also important to ask about other sexual contacts in order to possibly treat partners.
Can a trichomoniasis infection be cured?
Trichomoniasis can be treated well and therefore belongs to the group of curable sexually transmitted diseases. However, as trichomonads often do not cause any symptoms, the disease goes unnoticed for a long time – there is also the possibility that the disease will heal during this time.
An untreated trichomonas infection may have an impact on the course of a pregnancy. Important complications are premature birth and low birth weight. In rare cases, a trichomonas infection leads to ascending inflammation of the fallopian tubes.
If the infection spreads to a man’s urinary tract, prostate inflammation may develop in some cases.
How can a trichomonas infection be prevented?
To protect yourself from a trichomonas infection, you should use a condom during sexual intercourse. Good intimate hygiene is the basis of effective infection prophylaxis. Even if a trichomonas infection does not normally occur when bathing, it is advisable to put on dry clothes quickly afterwards.
