Sexual health tests

What is Trichomoniasis?

Trichomoniasis is a sexually transmitted disease caused by a parasite known as trichomonas vaginalis. The disease is often hard to diagnose as the symptoms mimic those of other sexually transmitted infections.

Up to half of all patients (both men and women) will display no obvious symptoms of the infection and could therefore be infected and not even know it. Even if you do not exhibit any symptoms you can still pass the infection on to others if you have been infected.

What are the symptoms of trichomoniasis?

Symptom can differ depending on whether the patient is male or female.

In men symptoms can include -

• Pain when passing urine or upon ejaculation
• The need to pass urine more often than usual
• A discharge from the penis which is usually thin and white in appearance
• Pain, inflammation and/or redness around the head of the penis (balanitis) or around the foreskin (balanoposthitis)

In women the symptoms can include -

• Pain or discomfort when urinating or engaging in sexual activity
• An unusual discharge from the vagina which may be either thick or thin and or frothy in appearance. The discharge may also have a green or yellow colour to it
• Production of more discharge than usual - this may also have an unusual and unpleasant 'fishy' smell to it
• The development of swelling, redness and/or an itch around the vagina. On the rare occasion this can also spread to the inner thighs

It is important to note that up to 50% of men and women will not display any symptoms and will therefore not know they are infected.

How do you become infected with trichomoniasis?

Trichomonas vaginalis, the parasite which causes trichomoniasis, is spread from person to person when they engage in unprotected sexual activity (sex without the use of a condom). The infection can also be spread by the sharing of sex toys which have not been cleaned properly or not covered with a condom before use.

In females, the parasite inhabits the vagina or the urethra (the tube by which urine is passed from the bladder out of the body). In men the infection is usually within the urethra but can also sometimes be found in the head of the penis or the prostate gland.

Anyone who is sexually active can catch the infection and pass it on. This means you do not necessarily have to engage in sexual activity with multiple partners to catch the infection. The infection is not known to be passed on through oral sex or through anal sex. It is also not passed on through kissing, hugging or holding hands. You cannot catch trichomoniasis by sharing cups, cutlery, plates or by using the same toilet seat.

Diagnosis & treatment of trichomoniasis

Your doctor or nurse will often conduct an examination of your genital region. By doing this your doctor is looking for physical signs and symptoms such as a discharge, inflammation or redness as mentioned in the symptoms section above.

If a physical examination is not possible, or there are no obvious symptoms present then a swab will be taken from the vagina or the penis. In men a urine sample may also be collected. If your doctor strongly suspects you may have the infection, then they may start treatment before the results come back. This is to stop the infection from spreading to others.

In the majority of cases, treatment is needed to treat the infection (on the rare occasion an infection may be cured on its own). Treatment usually involves a short course of antibiotics. Most people are prescribed an antibiotic called metronidazole which needs to be taken twice daily for 5-7 days (sometimes given as a concentrated single dose). An alternative antibiotic can be prescribed by a specialist if metronidazole is unsuitable (e.g. due to an allergy).

Follow-up testing is not usually required if the antibiotic has been taken as prescribed. If symptoms remain upon completion of the antibiotic course, then tests need to be conducted to rule out other sexually transmitted infections. A re-test should be completed if -

• The course of antibiotics was not completed or taken as prescribed
• You engaged in sexual activity during the treatment period - this could have resulted in you becoming infected again.
• You vomited shortly after taking the antibiotic dose(s) - this could have resulted in the treatment being ineffective.

Trichomoniasis in pregnancy

Complications with trichomoniasis are rare but pregnant women may be at a higher risk of complications. If you are pregnant and have been diagnosed with trichomoniasis, delaying treatment can result in -

• Premature birth (i.e. baby is born before the 37th week of pregnancy)
• Baby being born with a low birth weight

It is essential to have treatment as soon as possible following a positive diagnosis.

Chlamydia in pregnancy?

Chlamydia can result in complications during pregnancy. This can include -

• Premature birth
• Baby can be born with the infection. It can present itself as conjunctivitis (eye infection) or pneumonia (lung infection).
• Pelvic inflammatory disease (PID) also increases the likelihood of you experiencing difficulties in getting pregnant.
• There is an increased chance of you experiencing an ectopic pregnancy if you develop PID.

When can I have sex again?

If you have been diagnosed with trichomoniasis, then you are risking passing this onto a sexual partner each and every time you engage in sexual intercourse.

If you have started treatment following a positive diagnosis, then you should avoid engaging in sexual activity for the duration of the treatment or a minimum of seven days (whichever is longer). If you have been prescribed the once only course of metronidazole, then you should avoid sexual intercourse for a period of seven days after taking the treatment.

It is important to notify any sexual partners as soon as possible of the infection as they may pass it onto others. If you have a regular sexual partner, then they should be tested as soon as possible and treated to ensure you do not become re-infected.

Having been diagnosed and effectively treated, does not mean you will not catch the infection again. By using a barrier method (condom/dam) and not sharing sex toys (or covering them with a condom before sharing) will reduce the chances of you catching the infection again in future.

Useful Information

Click here for the NHS choices website on trichomoniasis.

Click here for more information on all sexually transmitted diseases.