Trichomoniasis: Diagnosis and Treatment

Trichomoniasis, commonly referred to as trich, is one of the most common sexually transmitted infections. More than 7 million people in the United States have contracted trich. Trich is preventable by practicing abstinence or through safe, monogamous sex, and the use of a condom. An effective cure for trichomoniasis does exist, but prolonged infection can cause swelling and tissue damage.

Why get Tested
Diagnosing trich is not always straightforward. Most men have few symptoms of trichomoniasis. Women are more likely to display symptoms, including yellow-green discharge, but they too can be asymptomatic. Due to the lack of symptoms in both men and women, it is important to discuss your level of risk with your health care provider and get tested. Otherwise, you run the risk of unknowingly infecting your sexual partner.

If you are a man, symptoms of trichomoniasis infection could include: painful ejaculation and urination, frequent urination, or a white discharge from the penis. If you are a woman, trich may look like a yeast infection. Symptoms often include: a yellow-green, odorous discharge, painful intercourse, painful urination, and abdominal cramping.

At the Doctor’s Office
In order to get a proper diagnosis, your doctor will need to meet with you to ask you a few questions and do a physical exam. Common questions that your doctor will likely ask you include whether you have had unprotected sex, if you have had multiple sex partners, and if you are suffering from any other STDs.

During the physical, your doctor will examine your genitals for signs of infection. Women will have a pelvic exam in which the doctor puts two fingers inside of the vagina and gently massages the abdomen. If you are a woman and have trichomoniasis, it is likely that your doctor will find small, red sores around your cervix. You will also have a wet prep performed.

For this test you will be asked to lie down and place your feet in stirrups. An instrument called a speculum will be inserted in your vagina. A speculum has two plastic blades that gently hold open the vagina, exposing the cervix. A brush or wet swab will be inserted into the speculum and swept around the cervix. This swab will be placed into a wet mount. In order to determine if you have trichomoniasis, the doctor will combine the parasite on the swab with salt solution, and place it on a slide. This slide will then be observed under a microscope.

If you are male and think you have trichomoniasis, your doctor will examine your penis and look for signs of infection. A sample of the discharge from your penis will also be taken and placed in a wet mount for examination.

It will take about a week for your doctor to confirm the results of your wet mount. Your doctor will look for evidence of the on the slide. The parasites that cause trich have tails, called flagella, which whip back and forth. If your doctor can see this on the slide, than you have tested positive for trichomoniasis.

The wet mount is not always sufficient to diagnose a case of trich. This process is only about 60% effective. In cases where the wet mount is inconclusive, a culture will be performed. Another sample of discharge will be taken and placed in a plastic dish. Bacteria thrive in these conditions, and any trichomoniasis parasites in your discharge will multiply quickly. Culture tests are 95% effective in producing a diagnosis. Women may also be given a vaginal pH test. A pH level over 4.5 could indicate the presence of trich bacteria.

Once diagnosed, the cure for trichomoniasis is relatively straightforward. If you test positive, you will be prescribed the drug metronidazole. This drug is effective in 90% to 95% of all cases. Metronidazole is given in either one large dose, or in a series of smaller doses taken over one week. Metronidazole is associated with some side effects including: aftertaste in the mouth, loss of appetite, and nausea. When taking metronidazole you must abstain from alcohol. Alcohol mixed with metronidazole can cause severe nausea and vomiting.

Metronidazole gel is sometimes used to treat symptoms of trichomoniasis. This gel is applied topically to the vagina, but is not very effective. It is generally only used when oral drugs are unwanted by the patient. If you have trich and are pregnant, your health care provider may wait to start treatment until your baby is born.

Natural cures are available for treating the symptoms of trich but their effectiveness is questionable and generally not recommended without consulting a professional first. You can wash with a douche twice a day. This douche can contain yogurt, vinegar, or herbs such as echinacea, calendula, and goldenseed. The douche will help dry up any discharge.

Eliminating carbohydrates and sugars from your diet may also help symptoms. Taking antioxidants including Vitamins A, C, E and zinc are also thought to be effective.

Left untreated, trich can lead to a variety of health problems. Not only can symptoms get increasingly worse, but the infection can also cause organ and tissue damage. In men, prolonged infection with trich can potentially damage the bladder as well as the prostate while in women untreated trich can cause the fallopian tubes to become inflamed. Trich can also potentially damage cervical tissue in women.

People infected with trich are also at a greater risk of catching other STDs, most notably HIV. It has been found that people with trich are up to five times more likely to be infected with the HIV virus than those people who do not have trich.

Follow Up
If your symptoms go away after taking medication, there is no need for a follow up visit. If symptoms of trichomoniasis persist, go back to the doctor. You will probably be given another course of metronidazole. If your symptoms still persist, the trich bacteria may have become resistant to metronidazole. Further tests will be necessary, and treatment with another drug required.

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