Trichomoniasis

Understanding the manifestations of a particular disease is akin to catching smoke – it is impossible to do it with baseline tools and knowledge, and necessary laboratory tests and processes are required to ensure that the diagnosis is accurate and on point. Of course, this goes without saying that a proper diagnosis is one step short of providing an appropriate treatment strategy, considering that the treatment methods for each condition are different from another, especially when it comes to diseases that, while being similar in presentation, are entirely different in terms of their pathogenesis.

This concept is true for nearly all diseases, but this is even more highlighted when it comes to diseases that target a particularly sensitive organ – one that will produce similar effects to most infectious and non-infectious conditions alike due to its heightened sensitivity and fragility. For instance, heart conditions would most commonly present with chest pain as its primary symptom along with other distinctive presentations that differentiate each unique situation, and problems in the head area would most often present with headache along with other descriptive symptoms that would allow physicians to pinpoint the exact source of the particular manifestation.

Understanding Trichomoniasis

In the case of conditions affecting the genitalia, the most common symptom that one would most often experience is irritation and discomfort, considering that the area is relatively sensitive to any stimulus – whether it is intrinsic or not. What makes this context even more concerning is that having a blur between what characterizes infectious conditions from non-infectious diseases makes it more challenging to prevent the further transmission of the infection. While it may be possible to diagnose the situation with ease using the appropriate testing procedure, the very fact that the symptoms are overlapping would inherently make it difficult to determine whether you need to perform preventive measures to avoid transmission, or even if you need to consult your physician for something that you might be experiencing down there. Sure, we do concur that it is always better to consult your physician if you are experiencing unusual symptoms, particularly in such a sensitive area, but the misconceptions and the simultaneous intimidating feeling coming from physicians would often discourage some people to instead address their condition on their own without having the slightest idea of how to differentiate their manifestations from a myriad of other diseases that can cause the same presentations.

In such a case, laypeople must be informed of the intricacies of specific conditions that affect the genitalia, primarily that sexually transmitted infections exist – ones that may cause relatively irreversible complications if the condition is not addressed immediately or adequately. For instance, Trichomoniasis, also known as “trich,” is a condition that presents with symptoms that are in line with the manifestations of various other diseases. While it is prevalent among the public, it only presents with a symptomatic manifestation in around 30% of the infected population – making it even harder to understand or even discern whether or not you have the infection.

It is irrefutable that diagnosing conditions like such are nearly impossible without the proper skill and tools necessary to provide a more conclusive outlook, and this is precisely the reason why understanding the disease as a whole would go a long way not only in recognizing the illness, but in asking for the right tests, employing the proper non-pharmacological prophylactic procedures, and approaching the right experts to address the condition as well. This outline might not necessarily equip you with the means to diagnose the disease independently, but it will provide you with an understanding of the next steps you should take.

To start, let us understand what Trichomoniasis is.

As previously mentioned, several conditions affecting the genitalia could manifest similarly with another disease that would require a completely different diagnostic procedure and testing regimen. While it does have some distinct qualities that physicians often use to develop their diagnosis with the help of the appropriate tests, it is easy to mistake the condition with other diseases when you only rely on the manifestations that you were able to observe.

What is Trichomoniasis?

Trichomoniasis is a common sexually transmitted condition prevalent among sexually active people of all ages. It is sometimes known as “trich” in more colloquial conversations, and it is known to be transmitted by a protozoan known as Trichomonas vaginalis. In this situation, it might be easy to misunderstand that with the name of the protozoa causing the condition, the disease might be only present in women, hence the word vaginalis. However, this is not entirely true as the condition can affect both men and women who are sexually active and were exposed to the causative organism during a particular interaction. The most commonly infected part when it comes to women is the lower genital tract which is composed of the vulva, vagina, cervix, and urethra. On the one hand, infections in men would often be seen inside the penis or in the urethra – causing its hallmark symptom of discomfort, irritation, and pain during urination. One must also understand that the condition may also present in other parts of the body such as hands, mouth, or anus, but these are relatively rare and are more dependent on the current health of the patient and their susceptibility to such infections.

How Prevalent is Trichomoniasis?

Trichomoniasis infections have been coined by the Centers for Disease Control and Prevention or CDC as the most common curable sexually transmitted disease. According to the CDC, there was an estimated number of Trichomoniasis infections of around two million in the United States in 2018, but this is still subject to various inconsistencies such as underreporting due to the majority of cases being asymptomatic. Based on several studies, it was found that Trichomoniasis remains asymptomatic in around 70% of the cases – making only a measly 30% of all infections symptomatic and perhaps even diagnosed on purpose. In most cases, trich diagnoses are entirely circumstantial due to either a routine STD testing process or an accidental diagnosis while testing for a completely different condition.

While it is not necessarily true that Trichomoniasis is a condition that is only present among women due to the name of the causative microorganism, i.e., Trichomonas vaginalis, it was, however, found that the infection is more common among women than men and that older women are more susceptible to the condition than younger women. The age difference can be attributed to a particular vulnerability in the immune system as we approach old age, but the exact rationale behind this difference cannot be pinpointed. The actual reason behind why the disease is mainly asymptomatic could not be specified either despite the various studies that have been done on the condition – settling for the assumption that it has something to do with the patient’s current immune system.

Is Trichomoniasis a Sexually Transmitted Condition?

While not all conditions affecting the genitalia are sexually transmitted, Trichomoniasis is certainly a sexually transmitted condition or STD due to its transmission process. It requires contact between infected and non-infected genitalia to transmit the infection and the protozoa to another individual.

In the case of Trichomoniasis, the infection can be transmitted from an infected penis to a healthy vagina, from an infected vagina to a healthy penis, from an infected vagina to a healthy vagina through same-sex intercourse. It might also be essential to note that while most Trichomoniasis infections are asymptomatic due to the inherent mechanism of the condition, it is still possible to transmit the disease from asymptomatic genitalia to a healthy organ – making it even more critical to have yourself tested regularly when you are generally a sexually active individual.

Who are at Risk for Trichomoniasis Infections?

Trichomoniasis infections are not necessarily particular with the patients that they can infect as their transmission can occur with essentially anyone – making anyone susceptible to the condition, especially when they are sexually active, to begin with. However, there are still particular risk factors that would sometimes heighten the possibility of an infection in a specific individual, mainly because these habits could either increase your exposure rate or increase your susceptibility to the microorganism’s transmission.

Sexual Intercourse

Sexual intercourse is perhaps already a given in this situation as the condition in question is sexually transmitted. Sexual intercourse is a risk factor that somehow increases a patient’s exposure rate, making it more likely for them to contract the condition from another individual if proper protective measures were not in place during the interaction. Sexual intercourse alone will not cause the condition to manifest, but it does put you in a place where you can be exposed to the condition.

Difference in Sex

Sexual differences are not necessarily absent in sexually transmitted infections due to the differing structures of the genitalia in both men and women. While it is relatively safe to assume that the mechanism is similar in both instances, it has been found by certain studies that women are, in fact, more susceptible to the condition than men. The exact rationale behind this difference has not been specified, but it does provide another risk factor that someone may look out for, mainly when their sex conforms to the risk factors associated with Trichomoniasis infections.

Nationality

According to the CDC, Trichomoniasis infections among African American women are 9.6%, 1.4% in Hispanic women, and around 0.8% among non-Hispanic white women. These numbers inevitably show a disparity between the prevalence rates among several nationalities and ethnicities – showing that African American women are, in fact, more susceptible to the condition than Americans are. In addition to that, according to the NHANES Study from 2013-2016, the prevalence of the disease among American women ages 14-59 is around 2.1%, and 0.5% among men – highlighting both the decreased susceptibility of American women and increased vulnerability of women over men in general as discussed in the previous point.

Poverty

While there is no established direct causality between poverty and the prevalence of the condition in the population itself, it was found that there may be some correlation between the two concepts in that it was found that there was an association between the subsequent effects of poverty and the existence of the condition. This may include poor hygiene, low sexual literacy, and other consequences of a below-average economic status.

Excessive Douching

It is a known fact that the vagina is a relatively sensitive organ because it has a mechanism by which it maintains a perfect balance between the good and bad flora existing in the genitalia. Through these processes, harmful bacteria are controlled by good bacteria through either the manipulation of the vaginal environment or by directly suppressing the harmful bacteria itself.

These processes, however, are disrupted when a woman washes their vagina excessively – destroying the balance of the environment and causing either the harmful bacteria to propagate or the good bacteria to uncontrollably multiply that it causes specific untoward effects to the patient. When such happens, the vagina is now susceptible to external infections due to the absence of its inherent protective mechanisms – making it highly possible that a patient will be infected by Trichomonas vaginalis when the patient comes into contact with an infected individual.

Existing Chlamydial Infection

Similar to how excessive douching weakens the defenses of the genitalia, an existing Chlamydial infection may cause the weakening of the defenses of the genitalia that would otherwise prevent the entry of other pathogenic microorganisms. With the genitalia being more susceptible to yet another infection, contact with an infected individual would almost always guarantee transmission – causing a Trichomoniasis infection that could either be asymptomatic or symptomatic.

Common Misconceptions Regarding Transmission

Considering that Trichomoniasis is one among the myriad of conditions that could all cause the same presentations that may include irritation and genital discomfort, it is effortless to build a variety of misconceptions about certain aspects of the disease – making it so that some people falsely associate certain beliefs to the condition without knowing its validity in actual practice.

While this may include some of the misconceptions that are often found regarding the condition’s transmission, this does not claim to cover every misconception that there is, considering that there might be several among the public that might be subject to each particular cultural habit or belief. These misconceptions highlight the most commonly associated misunderstandings that have often resulted in an increased prevalence of the condition amidst the assumption that the disease could or could not be transmitted in a certain way.

Need for Ejaculation

One prominent misconception that is often present regarding STDs is that the transmission of the condition only occurs during ejaculation or when a male participant releases their bodily fluids during climax. While this could cause transmission of the causative microorganism residing within the urethra of the genitalia, it is not necessarily the only way the microorganism can be transmitted from an infected individual to another healthy person. The transmission of STDs, particularly Trichomoniasis and its causative agent, Trichomonas vaginalis, can occur when there is contact between healthy tissue and an infected surface. Essentially, for as long as the genitalia of a healthy person touches the genitalia of the infected person, the transmission may occur for this highly contagious condition.

However, note that this is not necessarily the case for all STDs as there are instances where transmission only occurs when there is an evident transfer or contact with bodily fluids. This instance is more commonly observed in HIV infections where it is necessary for sexual/bodily fluids such as semen or blood for the virus to be transmitted to another person.

Transmission in the Presence of Symptoms

In the case of Trichomoniasis, where the condition is widely asymptomatic due to some unknown mechanism that somehow restricts symptomatic patients to only around 30% of the affected population, it is extremely easy to be confident that you somehow could not transmit the condition when you are not presenting any evident symptoms that could be a probable cause for worry. However, it must be noted that due to this asymptomatic nature of Trichomoniasis itself, the condition can still be easily transmitted to other healthy individuals even if the infection is asymptomatic in nature.

An asymptomatic case, in most contexts, essentially means that the microorganism or the infection is present within the body, but it has not proliferated or developed enough yet to cause a physical response from the body’s inherent defense mechanisms. However, this does not imply that you are free from the infection or that the microorganism is already dead and flushed from your system. It still exists in small quantities, increasing consistently despite its poor speed, still able to survive the transfer from one host to another given the appropriate means and circumstances.

As such, when you have been diagnosed as a carrier of the causative microorganism for Trichomoniasis, please do employ abstinence not only to protect yourself from further infections due to your susceptible condition but to protect others, particularly your sexual partner(s), from potential infections.

How Can You Protect Yourself from Trichomoniasis Infections?

It is known that infections are preventable with the proper procedures and means that could effectively deter the transmission of the microorganism or halt its growth completely. This has been applied in various fields where sterility is essential, and using it in the context of sexual health is just as critical in ensuring that you will not be contracting any condition that may cause untoward effects on your health. However, these protective measures are not necessarily 100% accurate as there is still a tiny chance that you might contract the microorganism from exceptional circumstances. Nevertheless, it is still leagues better to have yourself protected from potential infections instead of intentionally exposing yourself to conditions that may cause several irreversible complications when left untreated.

Abstinence

In the context of sexual health, abstinence is the top choice when it comes to preventing any transmission, as abstinence essentially removes you from the equation and cuts off the one source of the infection – sexual intercourse. While it is understandable that humans still do have urges and that complete abstinence is not entirely possible, especially in the case of couples who are trying to procreate, it is advisable to limit sexual intercourse to reasonable amounts as exposure to various instances and partners could relatively increase your risk for contracting the condition. This does not say that you need to abstain from all sexual contact to prevent any transmission completely, but it is irrefutable that abstinence would prevent the transmission of the microorganism entirely.

Monogamy

Monogamy is a concept that is slowly being blurred in modern society due to people who are yet to be ready to settle down but are willing to partake in sexual practices that do not involve commitments and responsibilities with their partners. This essentially means that some individuals have multiple sexual partners, and while there is nothing particularly wrong with such an instance, especially when no laws are being bypassed by the two participating individuals, having multiple partners would increase the risk of contracting the condition due to the high number of potential infection incidences throughout this interaction.

Practicing monogamy would essentially limit the potential sources of infection to one – making it so that you are aware of your partner's condition and that you will be immediately informed if your previous sexual partner did have a specific sexually transmitted disease. By having only one sexual partner, you are essentially limiting potential infection incidences – resulting in a much lower rate of infections than when you are blindly jumping through various sexual activities with several partners, not knowing the condition of each or whether they will be able to inform you in cases where they had an underlying condition later on. Again, knowledge is, most often than not, the key to reducing transmission.

Use of Contraceptives

Similar to how responsible sex is the driver for a lower transmission incidence, the use of protective tools such as contraceptives could significantly diminish the risk for potential infection, especially when both individuals are not aware of their current sexual health status. While it is certainly recommended to have yourself checked every couple of months to ensure that you are safe and that no underlying condition is silently progressing in the background, inevitably, some people would not have the time to perform such tasks consistently. Protect yourself instead to protect your partner as well.

How is Trichomoniasis Commonly Treated?

The most common treatment plan for Trichomoniasis is through the use of oral prescription medications tailored by your physician to the current progression of your condition. The medications recommended for Trichomoniasis cases are relatively safe to consume for pregnant women but do take note that it is still possible to be reinfected with Trichomoniasis following a successful treatment plan.

Trichomoniasis: An Outline of Its Mechanism

Trichomoniasis is a condition that is transmitted by a protozoan parasite known as Trichomonas vaginalis. This particular microorganism’s sole known host is humans, and its transmission can be effectively divided into three stages – transmission, replication, and infection.

Considering that the condition is known as one of the most common curable sexually transmitted conditions, the life cycle of Trichomoniasis essentially begins with its transmission through sexual intercourse. In this situation, the protozoa will be transmitted as trophozoites, and these will be stored in the lower genital tract among females and in the urethra and prostate in males. During this stage, the person is now at risk of developing an infection once the condition progresses. This can likewise be known as the diagnostic stage, as this is essentially the stage where the condition becomes diagnosable.

Following exposure, the trophozoites can proceed to the second stage, known as replication. These microorganisms will then undergo a process known as binary fission wherein the cell essentially duplicates into two – with the rest effectively doing the same until the microorganism amasses its numbers.

Once the microorganism has proliferated enough, it will proceed to its third stage of the infection. This is now essentially a full-blown infection that could directly cause transmission when the previously exposed patient participates in any sexual intercourse. This is also known as the infective stage due to the stage being mainly contagious when the patient reaches this particular progression.

Trichomoniasis: Symptomatic Manifestations

As previously discussed, Trichomoniasis is mainly asymptomatic – not showing any signs or symptoms in around 70% of the affected population, thus making it more difficult for physicians and laypeople alike to look for it when there is no reason to do it, to begin with. However, there are still certain instances wherein affected individuals present specific manifestations that may overlap with the presentation of other conditions.

Presentations

For infected men, the common symptoms that they would often experience when it comes to Trichomoniasis is infections include:

• Itchiness or irritation inside the penis
• Pyuria
• Painful ejaculation
• Discharge

On the one hand, women who are infected with Trichomonas vaginalis may present with manifestations that may include:

• Itchiness in the genitals
• Pyuria
• Dysuria
• Redness and soreness of the genitalia
• General discomfort while urinating
• Increased vaginal discharge
• Clear, white, yellowish, or green discharge that may have a fishy smell
• Urinary frequency
• Bleeding after sex

For both sexes, there will often be an uncomfortable situation during and after intercourse when it comes to the infected individual – making it essential for you to have yourself tested as soon as you experience an unusual sensation during sexual intercourse.

Incubation Period

While the condition is mainly asymptomatic due to its inherent mechanism, for symptomatic cases, the incubation period or the lag time between exposure and development of symptoms would often range within 5 to 28 days following exposure. There are some instances where affected patients experience symptoms at a later period, but this is essentially the common ground among examined symptomatic patients.

Duration of Symptoms

It is difficult to pinpoint a timeline for the duration of symptoms as it has been described by several resources as “coming and going” with no particular rationale behind its recurrence and resolution. However, it is known that if the condition remains untreated, the symptoms could persist for months or even years on end.

Trichomoniasis: Diagnosis and Testing Procedures

Several tests can be performed to properly diagnose the condition to determine whether you indeed have the infection in your system. This may include, but is not limited to, the following:

• Pelvic Exam
• Fluid Culture
• DNA Test

The tests performed for the diagnosis of Trichomoniasis are a mix of physical assessments and microscopic examinations that are all aimed towards the association of the common symptoms with the characteristics of the microorganisms found within the provided sample.

However, note that Trichomoniasis could not be diagnosed with an assessment of symptoms alone as its presentations are wildly similar to that of other sexually transmitted conditions. Apart from lacking a distinct manifestation that could distinguish the disease from the rest, it is likewise widely asymptomatic and would otherwise not be discovered unless the microorganism is found through microscopic analysis of the patient’s sample.

Trichomoniasis: Treatment and Management

The most commonly recommended treatment plan for Trichomoniasis is a single 2 g dose of oral metronidazole or tinidazole, but the dose is sometimes dependent on the patient’s circumstances and the current progression of the disease.

Treatment of Sexual Partners

It must likewise be noted that it is highly recommended that an infected patient’s recent sexual partner should again be assessed and treated for the condition to ensure that they have not been infected following a current incidence of exposure.

Frequently Asked Questions (FAQs)

Can you get Trichomoniasis more than once?

Yes. Reinfections are common, so utmost protection is still necessary even if you have been previously infected.

What is/are the complication(s) of Trichomoniasis?

Having Trichomoniasis essentially makes you susceptible to other STDs, particularly HIV, when you are exposed to a particular source of the infection.

How long should I wait before having sex again when I have been infected?

It would help if you waited for around a week following the completion of your treatment plan to ensure that the microorganism has been completely flushed from your body.

How does Trichomoniasis affect pregnancy?

Trichomoniasis may cause premature labor and low birth weight for infected pregnant women when left untreated.

Is Trichomoniasis completely treatable?

Yes. So long as the treatment plan is followed, the condition can be completely cleared from your system.