'The Trich'

Written by : Dr.M.D.Mazumdar, MD

Trichomonas Vaginitis also known as the 'Trich', is a sexually transmitted disease caused by a parasite, the Trichomonas Vaginalis.

The infection affects the urogenital tract and can be found in the prostate, prepuce of the penis and urethra of the male and in the vagina of the female. It can also be found in the folds around the clitoris.

Typically, only the female partner suffers from the symptoms of trichomoniasis. The male partner is usually symptom free.

Spread of Trichomoniasis

The organism passes from the penis to the vagina and vice versa in heterosexual sex. It can also pass from vulva to vulva to cause symptoms. But it rarely spreads in anal sex.

Women can acquire the disease from infected men or women, but men usually contract it only from infected women.

The organism needs direct touch to spread. It cannot spread through water or urine. It dies in normal water after 45-60 minutes, in hot water after 30 minutes to 3 hours and in diluted urine after 5-6 hours.

Symptoms occur after 5-28 days of exposure to the infection.

Trichomonas Vaginalis as seen
under a microscope

Signs and Symptoms

  • Severe Itching: The main characteristic and the chief complaint of the patient is severe vaginal itching. The itching may be all over the vulva but is more in and around the vagina.

    The labia minora and the vagina may become swollen and painful from the inflammation and constant scratching, so much so, that sexual intercourse may become difficult and painful. Sometimes, even walking and sitting may cause discomfort and pain.

  • Vaginal Discharge: The first symptom is usually a sudden onset of thick vaginal discharge often described as purulent (like pus). It can be greenish, yellowish or creamish in colour. It is usually bubbly and frothy in character. In rare cases, vaginal discharge may be minimal or scanty.

  • Pain: There may be pain around the external genital region. The genitals may feel hot and extremely sore with a dull, throbbing pain .

  • On Passing Urine: Pain is worse while passing urine as the acidic urine flows over the inflamed vulva. Many women resort to splashing cold water on the vulva with minimal relief. There may also be an urge to pass urine frequently.

  • During the Period: Itching and vaginal discharge is more just after the period ends but is present throughout the menstrual cycle.

On Examination: On examination, the vagina may be seen to be fiery red in colour and congested. There may be excoriation of the skin and scratch marks all over the vulva due to the constant itching.

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Treatment of Trichomoniasis

  • The drug of choice is metronidazole. It can be given in a single dose but is more effective when prescribed as 500mg tablet (1 tab to be taken two times a day for 5 days or 375 mg three times a day for 5 days).

    The sexual partner has to be treated at the same time to prevent reinfection.

  • Other drugs that act on Trichomonas are tinidazole and nimorazole.

  • Anti-inflammatory and painkilling drugs like ibuprofen 500 mg tablets ( 1 tablet to be taken three times a day after food)should also be prescribed.

Prevention of Trichomoniasis

The only way Trichomoniasis can be prevented is by wearing condoms during sexual intercourse. Like all other STDs, birth control methods like pills or intrauterine devices cannot stop spread of Trichomoniasis.

Complications of Trichomoniasis

The inflammation in the vagina increases a woman's risk of getting other STDs like HIV. If trichomoniasis occurs in a pregnant woman, it can cause premature rupture of the membranes and preterm delivery.

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