Written on March 19, 2023 by Sendra Yang, PharmD, MBA. 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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Trichomoniasis, also called trich, is a common sexually transmitted disease (STD) . The Centers for Disease Control and Prevention estimates 2.8 million people in the United States were infected with trichomoniasis in 2018 [1,2]. Trichomoniasis is more frequent in women than in men. The prevalence of trichomoniasis infection in the US is 2.1% in women 14-59 years of age and 0.5% among men the same age . Older women are more likely to be infected than young women .
The cause of trichomoniasis is an infection by a single-celled protozoan parasite, Trichomonas vaginalis [1,3]. T. vaginalis is a microscopic, motile organism described as having at least four flagella or whip-like tails [3,4]. The organism can live in moist environments for a few hours . When you are infected, the parasite can live in your urogenital tract and release proteins to destroy the epithelial lining and increase the vaginal pH [3,4]. This microscopic parasite is typically spread through unprotected sexual contact with someone who is infected [1,3].
Trichomoniasis infection is usually found in the lower genital tract, such as the vulva, vagina, cervix, or urethra in women [1,5]. In men, the infection is generally inside the penis, specifically the urethra. Other parts of the body are not commonly infected with the parasite. The exact time from exposure to the organism and infection is unknown, but it ranges from four to 28 days [1,5].
Risk factors that increase the chances of trichomoniasis include :
Most people with trichomoniasis are not aware of their infection, and symptoms vary among infected individuals [1,5]. Only about 30% of people with trichomoniasis develop any symptoms. Symptoms range from mild irritation to severe inflammation, differing for men and women.
In men, symptoms may include itching or irritation inside the penis, burning after peeing or ejaculating, and discharge from the penis [1,3,5]. Symptoms in women can comprise itching, burning, redness or soreness of the genitals, discomfort and pain when peeing or during sex, and having a clear, white, yellowish, or greenish vaginal discharge with a foul, fishy smell.
Trichomoniasis is diagnosed with symptoms, a physical exam, and a trichomoniasis test to confirm [1,3,6,7]. Your healthcare provider can examine your genitals and discuss your symptoms with you. Your provider can order lab tests to examine for the Trichomonas microorganism in samples such as urine or swabs from genital discharge. At-home lab testing can also check for trichomonas.
Not all STDs are curable, but trichomoniasis is the most common curable STD [1,8]. Treatment can reduce symptoms and signs of T. vaginalis infection and may even decrease transmission . Once you are diagnosed, a healthcare provider can prescribe you an oral antibiotic medication for treatment against the protozoal infection [7,8].
The drug class known as nitroimidazoles is the only one clinically demonstrated to be effective against trich infection [6-8]. The two nitroimidazole medications commonly used for treatment are metronidazole and tinidazole. Tinidazole is typically more expensive than metronidazole, with cure rates of around 92% to 100%, while metronidazole has approximately 84% to 98% .
You and your partner must be treated with medication together, or you will continue to reinfect each other . Even after being cured, you can still become reinfected with trich . About 1 in 5 people can have reinfection within three months after treatment.
When treating trichomoniasis with this drug class, you should not consume alcohol or any beverages containing alcohol [6-8]. The combination of alcohol and medication can cause severe nausea, vomiting, and rapid heart rate. These medications may also cause heartburn and a metallic taste in your mouth.
If you are experiencing symptoms of trichomoniasis or think you might have a trich infection, reach out to speak with a healthcare provider. You can schedule an appointment to see a provider at a medical office, or you could consider a telehealth visit.
If your healthcare provider determines that you have trichomoniasis, they will prescribe treatment. Your healthcare provider will recommend a prescription for trichomoniasis based on your gender and if you have any additional consideration concerns, for example, pregnancy, drug allergies, or HIV infection .
Everlywell provides access to a telehealth option for STD treatment online through Virtual Care Visits. If you think you may have an STD or have any questions about your sexual health, you can schedule an appointment with a certified healthcare provider. During your meeting, your clinician will provide individualized recommendations and next steps based on your symptoms and exposure history. This may include additional testing or prescription medication for trichomoniasis, if applicable.