Trichomonas: symptoms, causes, diagnosis and treatment of trichomoniasis

By Cristiano Antonino Last updated Jun 20, 2023

Trichomonas vaginalis is the name of a flagellated protozoan vehicle of a very contagious infection that can affect the genital area and urinary tract: trichomoniasis

Under the microscope, Trichomonas vaginalis appears as a large oval cell with flagella

Trichomonas does not penetrate into the tissues, but develops its pathogenic action by adhering to the epithelial cells.

In this case, with its flagella this protozoan is able to attach itself to the walls of the vagina, causing direct damage and altering the bacterial flora.

Trichomoniasis occurs mainly in women, with the involvement of a large part of the urogenital system, especially the urethra, vagina, cervix and sometimes also the urinary tract.

In humans, this infection appears to be of lower incidence.

Trichomonas: what are the symptoms

The symptomatological picture is different, depending on the gender of reference.

In male subjects the infection very often remains asymptomatic, and only in the rare cases in which the infection generates urethritis or prostatitis, can there be manifestations such as:

irritations to the glans
scanty or moderate urethral discharge
burning to urinate and during ejaculation.

Conversely, female subjects are more prone to the onset of symptoms since Trichomonas vaginalis infection often generates vaginitis, cervicitis and urethritis.

That said, the symptoms of trichomoniasis most easily found in women are

usually foul-smelling, greenish-yellow, foamy vaginal discharge, sometimes with small bloody spots
intense itching or burning in the external genitalia and vagina
dyspareunia, or pain during sexual intercourse
urination disorders, such as burning and need to urinate frequently.

Another fairly common outcome, found during a gynecological visit, is that of the so-called “strawberry cervix”.

The definition derives from the typical presence of small reddish spots on the surface of the cervical mucosa and on the vaginal wall.

Finally, it should be noted how the symptomatological picture is overall influenced by the trend of the menstrual cycle, reporting for example an accentuation of the symptoms in the presence of menstruation.

If not treated promptly, trichomoniasis often evolves from an acute form to a chronic-relapsing one, characterized by the alternation of asymptomatic phases and acute or subacute phases.

For this reason it is essential to seek medical attention at the onset of the symptoms mentioned above.

Complications

If neglected for years, or in any case not treated adequately, Trichomonas vaginalis infection can lead to serious clinical complications.

Specifically, trichomoniasis can involve:

infection of the uterus and fallopian tubes in women
irritation of the penis and inflammation of the prostate in men
sterility, both in women and men.

In addition, trichomoniasis appears to be a risk factor:

in the development of cervical cancer
in the transmission of HIV

As far as gestation is concerned, Trichomonas infection is associated with

ectopic pregnancies (i.e. the implantation of the fertilized egg does not take place in the uterine cavity but in an abnormal position)
premature rupture of membranes
deliveries preterm
low weight of the baby at birth.

Finally, in rare cases, the newborn can contract the infection during the passage through the birth canal and suffer damage of variable entity, from asymptomaticity to conjunctivitis and pneumonia.

Causes of trichomonas

The transmission of trichomoniasis occurs mainly through sexual contact (through unprotected vaginal, oral and anal intercourse), but can also occur indirectly through contact and/or use of infected clothing, sheets, towels or contaminated toilets.

Since Trichomonas vaginalis survives for a very short period of time outside the human body (about 40-50 minutes), indirect transmission occurs rather rarely, therefore the infected or carrier person is the primary source of contagion, through the passage of the infection to the healthy subject by means of the secretion of the mucous membrane.

In very rare cases, the so-called vertical transmission, i.e. from the mother to the newborn at the time of delivery, can occur.

The incubation of trichomoniasis is quite long and varies between 4 and 28 days.

How is Trichomonas vaginalis infection diagnosed?

It is performed with laboratory tests, with fresh microscopic analysis of the vaginal secretion.

Although it is possible to obtain a result quickly, the reliability of the test is around 60-70%, which is why an immediate examination of the vaginal smear taken is desirable.

Non-fresh tests such as immunochromatographic rapid tests can also be performed on the latter.

It is also possible to search for the protozoan using culture and amplification with PRC (polymerase chain reaction) or NAAT (nucleic acid amplification test) which are carried out:

in women or on the vaginal secretion or endocervical swab
in men on urethral swab or on semen
on urine in both sexes

Trichomonas: the cure

As far as the treatment of trichomoniasis is concerned, if the intervention is timely, the recovery is quite rapid.

Treatment for trichomoniasis mainly consists of taking specific antibiotics, such as metronidazole.

Alternatively, tinidazole is prescribed for infections resistant to the latter.

After conclusion of treatment it is important to avoid alcoholic beverages for at least 24 hours for metronidazole and 72 hours for tinidazole.

In fact, alcohol intake can lead to symptoms such as nausea, vomiting, abdominal cramps, hot flashes and headaches.

Abstention from relationships is recommended

Furthermore, it is advisable to accompany the antibiotic therapy with a probiotic supplement to facilitate the normal reconstruction of the vaginal bacterial flora.

It is also recommended to abstain from sexual intercourse until the end of the treatment.

Finally, remember that the treatment must also be extended to the sexual partner and it is important that this also happens in the case of asymptomatic trichomoniasis, to avoid the ping-pong effect (i.e. the continuous passage of the infection from one partner to other) and the possible infection of other people.

Both in sexually active women and men with Trichomonas vaginalis infection, considering the high incidence of recurrences in this type of pathology, a check-up is often recommended within 3 months of the end of treatment.

Are there measures to prevent the onset of Trichomonas vaginalis infection?

Prevention of trichomoniasis is carried out:

mainly through the appropriate and regular use of condoms during sexual intercourse, especially in the presence of occasional partners
screening tests if you have recurring vaginal discharge or other sexually transmitted infectious diseases such as gonorrhea or chlamydia.

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