Written on October 14, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Before we can answer what happens if trichomoniasis goes untreated, we need to first define what trichomoniasis is, its symptoms, and what treatments are available.
A common and curable sexually transmitted infection (STI), trich spreads in semen and vaginal fluids during sexual intercourse. The parasite Trichomonas vaginalis (T. vaginalis) causes the infection.
Trich is the most common nonviral STI in the world and is more common in Black women and people assigned female at birth (AFAB). However, anyone who has sex can get it. Approximately 3.7 million people in the United States have the infection.
Most people don’t have symptoms from the infection, so it is possible to have it and not know it. This means you can unknowingly infect others through sexual contact.
While symptoms only occur in about 30% of people infected, when they do present, they tend to appear within five to 28 days after exposure. Symptoms are more common in women or people AFAB. The reason why some people have symptoms and others don’t remains unclear.
Men and people AMAB rarely show signs of infection. Among those who do, the most common symptoms are:
Women and people AFAB tend to have more noticeable symptoms than men. Some of them are:
Healthcare providers treat trichomoniasis with antibiotic medication to kill the parasite causing the infection. Without treatment, trich can last for months or even years. It won’t go away on its own. The entire time you’re infected, you can give the infection to your sexual partners. All sex partners should be treated to prevent reinfection.
You shouldn’t have sex for one week after finishing the medication to give the drug time to kill off the infection and for symptoms to clear up. Having sex too soon can lead to reinfection.
You should see your healthcare provider in three months to ensure the infection is gone.
A woman with untreated trich has a greater chance of having an infected uterus and fallopian tubes. This infection is called pelvic inflammatory disease, or PID. If you have PID, it can cause belly pain, fever, and perhaps the inability to have children, a pregnancy outside the uterus (ectopic pregnancy), and chronic pelvic pain. While rare, it is possible to die from an ectopic pregnancy.
If you have trich when you are pregnant, you and your baby may encounter some health problems. You may have a premature delivery, and your baby may have a low birth weight.
Trich can also increase the risk of getting or spreading other STIs. For example, trich can cause genital inflammation, making it easier to get HIV or pass it to a sex partner.
If you’re diagnosed with trich, it’s important to tell everyone you’ve had sex with over the past two months, so they can be examined and treated, too.
In one study, researchers tracked the health of women in Mombasa, Kenya, to determine whether there is a relationship between Trichomonas vaginalis infection and an increased risk of human immunodeficiency virus type 1 (HIV-1) infection. At monthly follow-up visits, they tested the women for HIV infection and other STIs. A group of 1,335 female sex workers who were HIV-1 negative were monitored for about 566 days. In that group, there were 806 T. vaginalis infections, and 265 women became HIV positive.
Having trichomoniasis was associated with a 1.52-fold increased risk of HIV-1 acquisition after adjustment for potential confounding factors — things that were not measured in the study that could contribute to explaining the results. Women infected with T. vaginalis had a 52% higher chance of becoming infected with HIV.
Researchers identified four reasons why this is true. As mentioned above, genital inflammation, which we know is caused by T. vaginalis infection, increases risk because inflammation damages tissues in the affected area. Another kind of tissue damage from trichomoniasis affects capillaries, which can be seen as tiny hemorrhages in the skin. This makes it harder for the skin to act as a barrier. Another potential cause is that T. vaginalis has been shown to degrade an important molecule secreted by the body that normally would help block HIV infection. Finally, trichomoniasis could increase the risk of HIV-1 infection by increasing the likelihood of bacterial vaginosis (BV), a persistent imbalance in the bacteria that normally exist in the vagina.
Researchers concluded that treatment and prevention of T. vaginalis infection could reduce HIV-1 risk in women.
In another research study, T. vaginalis was found to be an important factor in HIV acquisition, especially in sub-Saharan Africa, where the prevalence of both T. vaginalis and HIV-1 are high. The researchers’ systematic review and re-analysis of data from previous research confirmed the evidence that infection with T. vaginalis increases the risk of HIV infection by 50%. Diagnosis and treatment of T. vaginalis infection in both high-risk and low-risk individuals may be a potential tool to reduce new HIV infections.
According to the Mayo Clinic, trichomoniasis is also associated with an increased risk of cervical cancer.
In another study, researchers reviewed 29 articles that included 473,740 women, of whom 8,518 were T. vaginalis-positive. Their results showed that T. vaginalis-infected women had 1.79 times higher odds of also being infected with HPV. They also found that T. vaginalis infection was associated with the presence of abnormal cells or cervical cancer. As such, their results showed an association between T. vaginalis and cervical carcinogenesis in sexually active women.
Some research has suggested that there is a connection between trich and prostate cancer; however, the evidence is not conclusive. For example, to explore this potential connection between trich and prostate cancer, researchers investigated the relation between a man having antibodies against T. vaginalis (which would indicate having been infected) and serum prostate-specific antigen (PSA) concentration, a marker of prostate infection, inflammation, and/or cell damage, in young, male, U.S. military members.
Of the 732 participants, 341 had a low T. vaginalis seropositive score and 198 had a high score, with the remainder seronegative. No significant differences were observed in the distribution of PSA by T. vaginalis serostatus. However, slightly greater, non-significant differences were observed when men with high T. vaginalis seropositive scores were compared to seronegative men, and when higher PSA concentrations were examined (≥0.70 ng/ml). Specifically, 42.5% of men with high seropositive scores for T. vaginalis had a PSA concentration ≥0.70 ng/ml compared with 33.2% of seronegative men.
Overall, their findings do not provide strong support for prostate involvement during T. vaginalis infection, although their findings for higher PSA concentrations do not rule this possibility out entirely. These suggestive findings may be relevant for prostate condition development because higher early- to mid-life PSA concentrations have been found to predict greater prostate cancer risk later in life.
Everlywell offers an at-home lab test that checks for trichomoniasis. If positive results are detected, you’ll have the opportunity to connect with our independent physician network and may receive treatment, if applicable.
Everlywell offers online STI consults in two hours or less. If you think you have been infected with trichomoniasis, fast and discreet care is just a click away. Create your health profile and complete an insurance coverage check (if paying with insurance). Book an on-demand video call and speak to a clinician within two hours. Get treatment and have a prescription sent directly to your pharmacy (if applicable).