SoftCare Clinic

Sexually Transmitted Infections

Trichomoniasis

Trichomoniasis: Gynecologist Consultation

Infection card

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  • From left to right: sample type · testing window (days) · cleared by treatment (pill) or virus persists (virus) · partner treatment · follow-up after 3 months · pregnancy screening · at the clinic or referral.

Window days are approximate; the doctor decides according to the test type.

Symptoms

In women:

  • Yellow-green, frothy, foul-smelling vaginal discharge (the classic picture is not seen in every woman)
  • Vaginal itching, burning, redness
  • Burning when urinating
  • Pain during sex
  • More discharge after a period or after sex

In men, most infections are symptom-free. If there are symptoms:

  • Mild discharge from the urethra
  • Burning when urinating
  • Itching or discomfort in the urethra

About 50–85% of women and most men have no symptoms. Some women with symptoms may have a “strawberry cervix”; this is mostly seen on colposcopy.

Diagnosis

The most reliable diagnostic method is the nucleic acid amplification test (NAAT / PCR). In women a vaginal swab is used; in men urine or a urethral swab. On wet mount microscopy, moving parasites may be seen; however, its sensitivity is low and it must be examined immediately. Antigen tests and culture may also be used.

A trichomoniasis test is recommended for women with discharge. Other STIs (chlamydia, gonorrhea, syphilis, HIV) should be assessed at the same time. If pregnancy is suspected, a pregnancy test is done first.

Treatment

Trichomoniasis is treated with nitroimidazole drugs. According to CDC 2021:

  • Women: metronidazole 500 mg twice daily for 7 days
  • Men: metronidazole 2 g as a single dose
  • Alternative (women and men): tinidazole 2 g as a single dose

Metronidazole can be used in pregnancy; tinidazole is not recommended in pregnancy. Avoid alcohol during and after treatment (24 hours for metronidazole, 72 hours for tinidazole).

All sexual partners should be treated at the same time. Avoid sex until treatment is completed and symptoms have resolved. In women, retesting after 3 months is recommended; reinfection is common. In men, there is not enough evidence for routine retesting. If there is no response to treatment, resistance or reinfection is considered.

Complications

Untreated trichomoniasis:

  • Can increase the risk of premature rupture of membranes, preterm birth and low birth weight in pregnancy
  • Can raise the risk of HIV transmission
  • Can increase the risk of pelvic inflammatory disease in women (especially together with HIV)
  • Can disturb the vaginal flora and increase the tendency to bacterial vaginosis

In men, prostatitis and, rarely, fertility problems have been reported. Antibiotics cannot reverse complications; early diagnosis is important.

Who should be tested

Women with discharge, itching or burning are tested for trichomoniasis. In high-risk settings (STI clinics) or for people with more than one partner or a previous STI, screening may be considered. If the partner is positive, testing and treatment are planned. Routine screening in pregnancy is not recommended for all women; it is assessed if there are symptoms or risk.

Prevention

  • Using a condom every time you have sex
  • Partner treatment
  • Avoiding sex during treatment
  • Follow-up test after 3 months (in women)
  • Assessment before planning a pregnancy

Having had trichomoniasis once does not give immunity. Reinfection is possible.

Our approach at SoftCare

At SoftCare Clinic, trichomoniasis assessment begins with a gynaecological history and examination. If there is discharge, a vaginal swab is taken; NAAT (PCR) is run at a partner laboratory. Tests for other STIs can be planned at the same time.

If the result is positive, metronidazole treatment is started. Informing the partner is discussed. If there is a pregnancy, the choice of treatment is adjusted accordingly. A follow-up test after 3 months is recommended. If there is severe pelvic pain or fever, PID is assessed. HIV treatment is not provided at the clinic; a referral is arranged if needed.

Appointments: +90 212 241 30 10 · softcareclinic.com

Trichomoniasis: Examination and Ultrasound
Ultrasound device in the examination room: the cause of discharge is distinguished through examination and sampling.

References

  • 1. Centers for Disease Control and Prevention (CDC). Trichomoniasis. STI Treatment Guidelines, 2021. https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm
  • 2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187.
  • 3. Kissinger PJ, Gaydos CA, Seña AC, et al. Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 CDC STI Treatment Guidelines. Clin Infect Dis. 2022;74(Suppl 2):S152–S161.
  • 4. World Health Organization (WHO). Guidelines for the Management of Symptomatic Sexually Transmitted Infections.
  • 5. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline on the Management of Trichomonas vaginalis, 2021.
  • 6. Merck Manual Professional Edition. Trichomoniasis.
  • 7. NICE Clinical Knowledge Summaries. Trichomoniasis – Complications.
  • Note: Treatment doses, management in pregnancy and follow-up intervals are updated by the physician according to current national and international guidelines. This reference list is for information only.

Listing a source does not mean SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: