Trichomoniasis is a common sexually transmitted infection caused by a parasite called Trichomonas vaginalis. It is treatable with antibiotics, but some important questions remain about trichomoniasis:
What is trichomoniasis?
Trichomoniasis is an infection caused by the protozoan parasite Trichomonas vaginalis. It is spread through sexual contact and is one of the most common curable sexually transmitted infections (STIs).
In women, symptoms of trichomoniasis may include:
- Green, yellow or gray vaginal discharge
- Fishy odor coming from the vagina
- Itching, burning or redness of the vulva
- Discomfort during urination or intercourse
Men with trichomoniasis often do not have symptoms. When symptoms do occur, they may include:
- Penile discharge
- Burning after urination or ejaculation
- Itching or irritation inside the penis
If left untreated, trichomoniasis can increase the risk of contracting other STIs. In pregnant women, it has been associated with preterm delivery and low birth weight babies.
What causes trichomoniasis?
Trichomonas vaginalis is a single-celled protozoan parasite. It is passed from an infected person to an uninfected person during sexual intercourse.
Infected women may pass the infection to men. However, women are more likely to be infected by men than vice versa.
The following factors increase the risk of contracting trichomoniasis:
- Multiple sex partners or a recent new partner
- A partner who has multiple partners
- Lack of condom use
- Douching
- History of STIs
- Exchange of sex for payment or drugs
How is trichomoniasis diagnosed?
Trichomoniasis is diagnosed through testing samples from the vagina or penis. Tests include:
- Wet mount microscopy: A sample of vaginal discharge is observed under a microscope for motile parasites.
- Culture: A vaginal swab is cultured to allow parasites time to grow.
- Nucleic acid amplification test (NAAT): A urine sample or vaginal swab is tested for T. vaginalis DNA.
Due to high false negative rates with wet mount and culture, NAAT is considered the most sensitive test. However, it may still miss some infections.
Men are harder to test than women, as they tend to have lower parasite levels. Repeated testing over several weeks may be needed to diagnose trichomoniasis in men.
What is the treatment for trichomoniasis?
Trichomoniasis can be cured with prescription antibiotic treatment. Options include:
- Metronidazole: Taken orally in a single 2g dose or a 7-day regimen (500mg twice daily for 7 days).
- Tinidazole: A single 2g oral dose, with fewer side effects than metronidazole.
Treatment is recommended for all sexual partners from the past 2 months. This helps prevent spreading or reinfection.
Most men and women are cured after a single dose of antibiotics. Even without treatment, symptoms usually resolve within 3-6 months.
Can you get trichomoniasis again after treatment?
Yes, it is possible to contract trichomoniasis again after successful treatment. This occurs through one of two ways:
- Reinfection: Having sex with an untreated or newly infected partner can lead to reinfection with trichomoniasis.
- Recurrence: In 5-20% of cases, T. vaginalis parasites can persist after treatment and cause recurrent infection.
To reduce the risk of reinfection or recurrence, all sexual partners should be treated and abstinence or condom use is advised for one week after treatment.
What can increase the risk of recurrent trichomoniasis?
Certain factors can increase the likelihood that trichomoniasis will recur after treatment:
- Having multiple sexual partners
- Inconsistent condom use
- Failure to ensure partners receive treatment
- Underlying genitourinary conditions like urethritis
- HIV infection
- History of previous trichomoniasis
- Parasite strains resistant to metronidazole
Women are also more prone to recurrent infection than men. Using condoms, limiting partners and completing the full antibiotic regimen can reduce recurrence risk.
Why does trichomoniasis keep coming back?
There are several reasons why trichomoniasis may keep recurring, even after treatment:
- Reinfection from an untreated partner: If a sexual partner has trichomoniasis but is not treated, transmission back and forth can occur.
- Persistent infection: The initial antibiotic treatment may have failed to fully eliminate the parasite from the body.
- Drug resistance: T. vaginalis can sometimes become resistant to metronidazole or tinidazole, allowing infection to persist.
- Concurrent STIs: Co-infections like chlamydia or gonorrhea can increase recurrent risk.
- Irritation during sex: This can create favorable conditions for parasite survival.
- Natural parasites: T. vaginalis is a naturally occurring organism in the vagina, allowing for repeat introductions.
Using condoms consistently, screening and retreating partners, and taking the complete antibiotic regimen can help stop recurrence.
What problems are caused by recurrent trichomoniasis?
Recurring bouts of trichomoniasis can cause several problems:
- Persistent symptoms like discharge, itching, and pain during sex or urination
- Increased risk of acquiring or transmitting HIV
- Pregnancy complications like premature rupture of membranes, preterm birth and low birth weight
- Infection spreading to the upper genital tract in women, causing pelvic inflammatory disease
- Scarring and fibrosis leading to infertility or ectopic pregnancy
There is also a concern that antibiotic resistance may develop with repeated treated episodes of trichomoniasis.
How can recurrent trichomoniasis be prevented?
Steps that can help prevent recurrent episodes of trichomoniasis include:
- Completing the full prescription of antibiotics
- Abstaining from sex or using condoms consistently and correctly
- Ensuring all sexual partners get tested and treated
- Avoiding douching, which eliminates good bacteria
- Getting retested after treatment
- Seeking prompt treatment for recurrent symptoms
- Considering alternative antibiotics if drug resistance is suspected
Ongoing, open communication with sexual partners is key. Couples should establish sexual exclusivity or continue using protection to avoid reinfection.
Can recurrent trichomoniasis be cured permanently?
Eliminating trichomoniasis permanently is challenging because:
- It is a stubborn infection prone to recurrence.
- Reinfection is common from untreated partners.
- Some parasites may be resistant to standard antibiotics.
However, curing trichomoniasis forever may be possible by:
- Establishing mutual monogamy with an uninfected partner.
- Completing antibiotic regimens until repeat testing shows clearance.
- Retesting regularly to detect and treat any recurrence.
- Considering alternative antibiotics if resistance is found.
- Using condoms 100% of the time, even in committed relationships.
- Avoiding sex completely for several weeks to months.
Permanent cure requires diligence from both partners. But with concerted effort, it may be possible to eradicate this stubborn infection.
What antibiotics can you take if metronidazole doesn’t cure trich?
If metronidazole fails to cure trichomoniasis, other antibiotics options include:
- Tinidazole: Another nitroimidazole antibiotic that may be effective if trichomoniasis is metronidazole-resistant.
- Paromomycin: An aminoglycoside antibiotic sometimes used vaginally or orally to treat trichomoniasis.
- Furazolidone: A nitrofuran antibiotic that has shown efficacy against metronidazole-resistant trichomonads.
- Nitazoxanide: A broad-spectrum antiparasitic drug used off-label to treat metronidazole-resistant trichomoniasis.
Alternative combination regimens may also be used, such as metronidazole plus tinidazole or metronidazole followed by paromomycin.
Treatment should be followed up with a test of cure to confirm eradication of the parasite. If antibiotic resistance is suspected, consider sending a sample to the CDC for special testing.
Does trich ever go away permanently?
It is possible for trichomoniasis to go away permanently, but this can be challenging to achieve.
With appropriate treatment, symptoms of trichomoniasis usually go away within 1-2 weeks. However, 5-50% of patients experience recurrence within 3 months.
To permanently eradicate trichomoniasis:
- Take the full prescription of antibiotics, even if symptoms resolve sooner.
- Ensure all sexual partners within the past 2 months get tested and treated.
- Use condoms correctly every time you have sex.
- Get retested for trichomoniasis within 3 months to confirm cure.
- Practice mutual monogamy with an uninfected partner.
Even with treatment, T. vaginalis can persist in 1-5% of women and 15-50% of men. This small reservoir allows recurrences.
For sexually active individuals with multiple partners, permanent cure is difficult. But those in mutually monogamous relationships have the best chance of eradicating trichomoniasis for good.
Can men get rid of trichomoniasis forever?
It is possible for men to get rid of trichomoniasis forever, but it can be challenging.
With antibiotic treatment, most men are cured after a single dose of metronidazole or tinidazole. However, trichomoniasis recurs within 3 months in 15-50% of treated men.
Here are some tips to help men permanently get rid of trichomoniasis:
- Take the complete antibiotic treatment as prescribed.
- Abstain from sex or use condoms for 1 week after treatment.
- Ensure all partners from the past 2 months get treated.
- Get retested at 3 months to confirm cure.
- Limit sex partners and practice mutual monogamy if possible.
With only one uninfected, monogamous partner, men stand the best chance of permanently clearing trichomoniasis. But even with treatment, traces of the parasite can persist in the prostate and seminal fluid.
While challenging, permanent cure is possible for men with diligent partner treatment, retesting, and safer sexual practices.
Conclusion
Trichomoniasis is a common STI that often causes recurring infection, even after treatment. Permanent cure requires:
- Completing full antibiotic regimens until testing confirms eradication.
- Treating all partners and avoiding unprotected sex until cured.
- Practicing long-term mutual monogamy with an uninfected partner.
- Retesting regularly to detect and treat any recurrence.
With diligence, it may be possible to eliminate trichomoniasis permanently. But maintaining cure requires great effort by sexually active individuals and their partners.
| Key Steps | Notes |
|---|---|
| Take full antibiotic regimen | Even if symptoms resolve sooner |
| Treat all partners | Within past 2 months |
| Retest in 3 months | Confirms parasite eradication |
| Use condoms consistently | Avoid reinfection until cured |
| Limit partners | Mutual monogamy ideal |
| Retest periodically | Detect and treat any recurrence |
With concerted effort by all partners, permanent freedom from trichomoniasis is possible but challenging to achieve in the long term.
