TRICHOMONIASIS

Quite the trich!

By Bailey Osmer

Figure 1: Trichomonas Vaginalis under a microscope (1).

What is trichomoniasis?

Trichomonas vaginalis is a silent roommate in the world of parasites. This protozoan parasite causes trichomoniasis or “trich” for short, it’s usually asymptomatic when acquired, although symptoms can occur. Trichomoniasis is the most common sexually transmitted infection in the United States and it does not take much to manage it. T. vaginalis is not a scary thing as it is the most common STI, what is scary is what trich can lead to if left untreated.

Who discovered trich and how?

Alexandre Dooné was the first person to describe the presence of T. vaginalis in vaginal discharge in 1836. The lack of scientific tools made it hard for him to study trich. He was able to get an illustration of the protozoan and observe its movement (5). He tagged the name Trichomonas because of two previously found protozoans that had similar physical structures and movements. Something that he did note was that the protozoan had a flagella to help with moving and could only be found in vaginal mucus.

In a book that he released 10 years later he included a picture of T. vaginalis from a vaginal smear which included pus cells, trichomonas, and epithelial cells in it. Donné was not able to specify what diseases Trichomonas could cause but he was able to let other scientists know that it was always associated with pathologic conditions much like syphilis which was found earlier on and gonorrhea found later down the line. Donné stated in his book where the pus mucus is found it may contribute to uterine cervix diseases later down the line. Kunstle, another researcher, is credited with observing the behavior of trich in the female urinary tract. Because of this we have a better understanding of trichs lifecycle today.

How can you get trichomoniasis?

Trichomoniasis is spread through unprotected sex vaginally. The parasite is passed from person to person when semen or vaginal fluids enter the penis or vagina. There are about 3.7 million people in the United States that have this infection and if you were to add in the people who are asymptomatic, that number might double. In women the vulva, vagina, cervix, or urethra are the most commonly infected part of the body and for men it’s the urethra (3). 

Life Cycle

Figure 2: Life cycle of T. vaginalis- The trophozoite (seen at a bigger size bottom left) lives in the female's genital tract or in the males genitalia. Then the protozoan multiplies by binary fission, where it develops into its infective stage and moves to urethra opening. During sexual intercourse an infected male ejaculates into an uninfected female, she now becomes infected. The protozoan migrates to her genital tract and the cycle restarts.

Signs and symptoms

70% of people do not report symptoms when tested positive for trichomoniasis (3). When there have been reported symptoms there seems to be a trend.

For women:

●     Itching, burning, redness or soreness of the genitals;

●     Discomfort with urination;

●     A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell. (STD fact sheet)

For men:

●     Itching or irritation inside the penis;

●     Burning after urination or ejaculation;

●     Discharge from the penis. (3)

Trich is most commonly mistaken for a urinary tract infection since they have similar symptoms. Oftentimes it takes at least 28 days for trichomoniasis to show up on tests because it needs time to develop in the new host (4).

What can trichomoniasis lead to?

Trichomoniasis is nothing to worry about if it is detected early on but let’s say that you are someone who is asymptomatic, what can this mean for you long term?

“In recent years, T. vaginalis infections have been associated with several adverse outcomes, including pelvic inflammatory disease, premature delivery, low birth weight, and increased susceptibility to HIV infection” (2).

Prevention and treatment

The only way to keep yourself from obtaining any STD’s/STI’s is to not partake in sexual intercourse. Many people tend to not get tested because they see it as being shameful or dirty.  If you choose not to get tested regularly, your safest bet is to wear condoms. Trich is not spread through touch, so hugging, a hand shake, sharing drinks, will not put you at risk of becoming infected. If you do get tested it is recommended that you get tested often since there are infections that do not always come with symptoms.  It is common for people to get reinfected after treatment so continue to get tested and let your sexual partners know to get tested as well.

If you do test positive for trich there are medications that you can take to make it go away.  Metronidazole or tinidazole are antibiotic medications that you can take, they are used to specifically fight protozoan infections (3).

References

1.    *, N. (2018, November 15). Trichomoniasis. Retrieved April 17, 2020, from http://www.clpmag.com/2018/11/routine-nucleic-acid-amplification-testing-trichomoniasis/

2.    Barbara Van Der Pol, James A. Williams, Donald P. Orr, Byron E. Batteiger, J. Dennis Fortenberry, Prevalence, Incidence, Natural History, and Response to Treatment of Trichomonas vaginalis Infection among Adolescent Women, The Journal of Infectious Diseases, Volume 192, Issue 12, 15 December 2005, Pages 2039–2044, https://doi.org/10.1086/498217

3.    “STD Facts - Trichomoniasis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 Feb. 2020, www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm.

4.    Ducre, Kristena. “Trichomoniasis Symptoms & Testing in Men and Women.” STD Exposed - Sexual Health Blog, 4 Mar. 2019, www.stdcheck.com/blog/everything-about-trich-and-trichomoniasis-testing.

5.    The Discovery of Trichomonas vaginalis. Acta Cytologica 1998;42:1075-1075. doi: 10.1159/000331985