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What is Trichomoniasis? How to spot symptoms and complications early

Trichomoniasis Explained

Trichomoniasis is a sexually transmitted infection (STI) that’s thought to be the most common non-viral STI in the world. It’s less common in the UK than some other STIs, however, according to Patient, in England in 2016 there were just over 7,000 new diagnosed cases of trichomoniasis – also sometimes called trichomonas – compared with more than 202,000 of chlamydia, more than 36,000 of gonorrhoea and almost 32,000 of genital warts.

However, trichomoniasis may be more common in this country than we currently think, as many cases may not be recognised or diagnosed, and some may also be mistaken for other STIs.

Trichomoniasis is an infection caused by a tiny parasite (protozoan) called Trichomonas vaginalis. But despite its medical name, it doesn’t just affect women, as both sexes can be infected. The parasite infects the genital area, most commonly the urethra (the tube that carries urine out of the body from the bladder). It can also infect the vagina and, sometimes in men, the prostate gland or the head of the penis.

Trichomoniasis is easily spread through having unprotected vaginal sex or sharing sex toys that haven’t been washed or covered with a new condom before each use. It’s not thought to be passed on by having oral or anal sex, and you also can’t catch it by kissing, hugging, sharing things like cups or cutlery or by using toilet seats.


Are you at risk?

Whether you’ve just had one sexual partner or many, you can get trichomoniasis if you’re sexually active. Your risk of getting it may be higher if:

  • Your sexual partner has trichomoniasis.

  • You’ve recently had unprotected sex with a new partner.

  • You or a partner have had unprotected sex with other people.

  • You have another sexually transmitted infection.


According to Patient, trichomoniasis is also most common in younger people under the age of 25, and there are 10 times as many cases found in black ethnic minority UK populations as there are in the general UK population.
 


What are the symptoms?

If you have trichomoniasis you may not realise it as many people – around 50 per cent – don’t get any symptoms, including many infected women and most infected men. If you do get symptoms, they usually appear within a month of coming into contact with the virus. The symptoms can also be easily confused with those of other STIs.
 

Symptoms in women

If you’re a woman with trichomoniasis you may experience any of the following:

  • An abnormal vaginal discharge – this is thought to be common. It usually has an unpleasant or strong smell, and can be white, clear, green or yellow in colour and have a frothy texture.

  • Itching, swelling and soreness in the vaginal and vulval areas, sometimes spreading into the groin. This can feel uncomfortable, and having sex may even be painful.

  • Pain or discomfort in the lower abdominal area.

  • Soreness during urination.
     

Symptoms in men

  • Discharge from the penis that may be thin and white in colour – this is thought to be common.

  • Irritation inside the penis.

  • Needing to urinate frequently.

  • Itching, swelling, soreness and redness around the head of the penis or the foreskin.

  • Soreness during urination and ejaculation.

If you notice any of these symptoms it’s important to get tested for trichomoniasis.


Complications of trichomoniasis

If you don’t have treatment for trichomoniasis, the infection can last for months or even years. Even if you don’t have any symptoms you could go on to develop complications, plus you may easily pass the infection on to others.

Complications can include the following:

  • Reduced fertility
    Both men and women with untreated trichomoniasis can be affected by reduced fertility. 

  • Pelvic inflammatory disease
    Women may also go on to develop pelvic inflammatory disease, which is an infection of the internal reproductive organs including the uterus (womb), fallopian tubes and sometimes also the ovaries. This can cause a range of symptoms, including lower abdominal pain, low back pain, high temperature, abnormal vaginal bleeding and discharge, and pain during sex

    One possible complication of pelvic inflammatory disease is infertility, plus you may also have an increased risk of having an ectopic pregnancy (pregnancy outside of the uterus).

  • Bacterial vaginosis
    This can also affect women with trichomoniasis. Bacterial vaginosis is very common, and is caused by an overgrowth of bacteria in the vagina, causing an abnormal and sometimes strong smelling discharge. Bacterial vaginosis is not, however, a STI.

  • Birth problems
    Pregnant women with untreated trichomoniasis have an increased risk of having their baby prematurely (before the 37th week of pregnancy) as well as having a baby with a low birth weight. They may also have a risk of developing sepsis – a serious reaction to severe infection – after childbirth.

  • Prostatitis
    This is rare, but in some men trichomoniasis can cause an infection of the prostate gland.

  • HIV
    Having untreated trichomoniasis means you may have an increased risk of developing HIV if you have unprotected sex with a HIV-infected partner. If you have HIV yourself, having trichomoniasis means you may also be more likely to pass the virus to your partner.


Trichomoniasis does not, however, cause cervical cancer.


Trichomoniasis diagnosis and treatment

If you have any of the symptoms of trichomoniasis, or if you’ve had unprotected sex with someone who you know has – or may have – the infection, you can have a test straight away to find out if you’ve been infected. Tests are available at some GPs’ surgeries, at sexual health or genitourinary medicine (GUM) clinics, and at some contraception clinics and young people’s services.

Click here to find sexual health services near where you live.

Your partner should also be treated at the same time, as well as anyone you have had sex with during the four weeks before your symptoms started. You may be advised to have tests for other STIs too, since it’s common for people with trichomoniasis to have other infections.

The test often involves a physical examination of your genital area first, then your doctor or nurse will take a swab to be analysed for signs of the trichomoniasis infection. If you’re a man you may also be asked to provide a urine sample.

Depending on where you get tested and what facilities are available there, you could get your results straight away or you may have to wait a week or up to 10 days. However, if there’s a good chance you do have trichomoniasis you may be advised to start your treatment before your results arrive. This aims to make sure there’s as little risk as possible of the infection spreading.


Effective antibiotics

The treatment for trichomoniasis is a course of antibiotics, with most people prescribed an antibiotic called metronidazole. This is very effective at treating the infection, but you have to make sure you take it correctly – in other words, exactly as prescribed. Usually this means taking a tablet twice a day, ideally after having food, for five to seven days.

Some side effects have been linked with metronidazole, including nausea, vomiting and an unusual taste in your mouth. If vomiting is a problem, you should go back to your GP or clinic, as vomiting after taking your tablets can make the treatment ineffective.

You should also avoid drinking alcohol while taking metronidazole, as mixing the two can cause more serious side effects, including heart palpitations and skin flushing.

Your symptoms should start to improve within a few days of starting to take your treatment. However, you should abstain from sex while you and your partner are still having treatment and for another seven days afterwards.

Unfortunately, having trichomoniasis doesn’t mean you’re immune to the virus, which means you can get it again after being treated. To protect yourself against being reinfected as well as to prevent getting other STIs such as chlamydia, HIV and gonorrhoea, it’s essential to use condoms every time you have sex. If you can, don’t share sex toys with anyone – but if you do, make sure they’re washed thoroughly and covered with a new condom before each time you use them.


Natural support for trichomoniasis

If you’re being treated with antibiotics for trichomoniasis, using natural supplements may help boost your immune system, which could make your body recover more effectively. Immune-supporting supplements include the following:


Live bacteria

Experts believe live bacteria – also called ‘friendly’ bacteria or probiotics – may help regulate and support the immune system (i). These live bacteria are thought to help restore the natural balance of bacteria in your gut. Live bacteria are available in supplement form, but you could also add more of these foods and drinks to your diet, such as sauerkraut, live yoghurt, kefir and kombucha.


High-strength multivitamin and mineral

As well as having a healthy diet, taking a high-strength multivitamin and mineral supplement may help make sure your immune system is getting all the nutrients it needs to stay as strong and effective as possible, especially when dealing with infections. For the best results, a multivitamin and mineral supplement should include good levels of zinc, which is thought to be important for immune function (ii) as well as vitamin D (iii).


Elderberry juice

Another supplement that may be useful for immune health is elderberry extract as it contains powerful antioxidants called anthocyanins. There is also evidence to suggest black elderberry extract increases the body’s production of chemical messengers within the immune system called cytokines, suggesting it has an immune-supporting function (iv).


Vitamins B and C

Both of these vitamins support the normal functioning of the immune system. But despite the fact that they’re found in a wide range of everyday foods, many of us may be running short. To make sure you’re getting the level of the B and C vitamins your immune system needs, you may want to consider taking a high-quality B complex supplement as well as a high-quality vitamin C supplement. You can also get both nutrients in good levels in a quality multivitamin and mineral formulation.

Eating a healthy balanced diet may also help, as a nutritious diet can help give your immune system the supports it needs for your body to heal. Some natural health practitioners also believe cutting back on sugar as much as possible could help your immune system work more effectively.



References:

  1. , Probiotics and immune health. Curr Opin Gastroenterol. ;27(6): 496–501. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006993

    , , , et al. Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium (Bifidobacterium lactis HN019): optimization and definition of cellular immune responses. Eur J Clin Nutr. ;54:849-8551. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11114680

  2. Trace element regulation of immunity and infection. J Am Coll Nutr. ;4:5-16.

    , , , et al. Interrelationships between zinc and immune function. Fed Proc. ;45:1474-1479. Available online: https://www.sciencedirect.com/science/article/pii/S0271531782801164

  3. Vitamin D and the Immune System. Investig Med. ;59(6):881-886. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406

  4. , , The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. ;12(2):290-6. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11399518