Trichomoniasis: Symptoms & Treatment – Trichomoniasis in Women

Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. It can affect both women and men, although it tends to produce far more noticeable symptoms in women.

The condition often causes yellowish or greenish discharge, an unpleasant odour and itching – symptoms that can easily be mistaken for other vaginal infections. If left untreated, the infection may persist for months or even years and lead to complications.

Looking after your intimate health begins with having the right information. Read on to learn how to recognise the signs of the infection and to understand the treatment options that can help you avoid risks to your intimate health and fertility.

What is trichomoniasis

Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis – a single-celled, anaerobic protozoan transmitted mainly through unprotected sexual intercourse, in both women and men.

Although the parasite can infect both sexes, it more commonly affects sexually active women, particularly those aged between 40 and 49, causing a vaginal infection, a urethral infection, or both. In men, the infection is confined to the urethra.

In terms of global prevalence, trichomoniasis is the most common non-viral sexually transmitted infection. In 2020, the WHO (World Health Organization) estimated the number of new infections worldwide at 156 million per year.

One important characteristic of this infection is that symptoms may appear between 5 and 28 days after transmission, though they often emerge much later. What's more, infection with Trichomonas vaginalis is very frequently symptomless, which means those affected may have no idea they are infected.

Statistics show that more than 70% of infected patients have no symptoms, as the parasite can survive in the urogenital tract without triggering severe inflammation. The absence of clinical signs encourages unwitting transmission and delays diagnosis, allowing the infection to persist over the long term.

Causes and routes of transmission of trichomoniasis

The main route of transmission for trichomoniasis is unprotected vaginal intercourse. In some cases, transmission is also possible via contaminated sex toys if these are not properly cleaned between uses.

Contrary to widespread rumours, trichomoniasis is not transmitted through contact with shared objects, swimming pool water, using the toilet or through laundry. These are simply myths. The parasite cannot survive for long outside the human body, which makes infection via surfaces or objects in the environment unlikely. Transmission occurs through direct contact between the genital mucous membranes and through the exchange of vaginal or urethral secretions.

The period between infection and the appearance of symptoms – the so-called incubation period – ranges from 4 to 28 days. Often, however, the infection remains symptomless for a prolonged period, which makes transmission to partners more likely.

This is precisely why the risk of infection is higher among people with multiple sexual partners who do not use condoms. In addition, factors such as a weakened immune system and other concurrent genital infections can make infection more likely to take hold.

Symptoms of trichomoniasis in women and men

Infection with Trichomonas vaginalis presents differently depending primarily on sex. However, symptoms and their intensity can also vary from person to person. Sometimes they are clearly pronounced, sometimes they are entirely absent for long periods – as is the case in 70 to 85% of instances.

Symptoms of trichomoniasis in women

In women, trichomoniasis mainly affects the vagina and the urethra. Symptoms may be mild or so pronounced that they interfere with everyday life. They include:

• Copious, frothy discharge that is greenish or yellowish in colour, with an unpleasant odour.
• Pruritus (itching in the intimate area) and burning in the vaginal area.
• Discomfort or pain during intercourse.
• Mild lower abdominal pain.
• Frequent urination or burning on urination.

Symptoms of trichomoniasis in men

In men, the infection is confined to the urethra and in most cases is symptomless or causes only mild discomfort.

Symptoms occur rarely and may include burning on urination, a small amount of urethral discharge or mild irritation of the glans, associated with urethritis.

Asymptomatic trichomoniasis

Asymptomatic trichomoniasis is problematic because the infected person can pass the parasite on without knowing. The absence of symptoms often delays diagnosis and treatment and allows the infection to progress.

For this reason, regular screening for sexually transmitted infections and testing of both partners are essential for sexually active people – particularly where risk factors are present.

Trichomoniasis and menstruation – the link between the infection and your cycle

Trichomoniasis can alter the appearance of vaginal secretions before or after menstruation, which is why these are sometimes mistaken for abnormal bleeding.

Changes in vaginal pH can intensify certain symptoms during menstruation, such as an unpleasant odour or frothy discharge. In some cases, the infection may be accompanied by light spotting between periods. In addition, while trichomoniasis does not cause delayed menstruation, it can change how the bleeding is perceived, making it appear heavier or differently scented.

Do make sure to use pads and tampons made from 100% organic cotton during your period – free from fragrances or other substances that can alter intimate pH and intensify unpleasant odours.

If you suspect an infection, it is advisable to avoid sexual intercourse during menstruation, as the risk of transmission may be higher at this time.

Diagnosing trichomoniasis and medical tests

It is advisable to see a doctor if symptoms of the condition appear or if there is a risk that your partner is infected. Trichomoniasis is diagnosed following a clinical examination by a specialist and confirmed by laboratory tests.

Clinical examination for trichomoniasis

During the consultation, the gynaecologist or urologist assesses the clinical signs in the vaginal or urethral area. In women, they check for copious discharge, signs of inflammation or tenderness of the cervix. In men, there may be signs of urethritis.

To confirm the suspicion, the doctor takes a sample of vaginal or urethral secretions, which is then examined under the microscope or sent off for further laboratory analysis. As the symptoms of trichomoniasis can resemble those of other genital infections, confirmation by specific tests is required.

Laboratory tests for trichomoniasis

Infection with Trichomonas vaginalis can be confirmed in several ways. The choice of method depends on the availability of the tests and your doctor's recommendation:

• Direct microscopy: allows the live parasite to be detected in freshly collected secretions. The method is quick, but sensitivity is low (the parasite may not be detected even though it is present).
• Rapid antigen tests: detect specific components of the parasite and deliver results within a few minutes.
• Culture for Trichomonas vaginalis: has higher sensitivity than direct microscopy, although it may take a few days for results to become available.
• PCR / NAAT tests (nucleic acid amplification tests): represent the modern diagnostic standard, offering the highest accuracy and the ability to detect even the smallest amounts of the parasite's genetic material.

Differential diagnosis of trichomoniasis

The symptoms of trichomoniasis can be confused with those of other vaginal or sexually transmitted infections. Itching, altered vaginal discharge, discomfort during intercourse or on urination are not specific signs of trichomoniasis and may also point to conditions such as candidiasis, bacterial vaginosis or gonorrhoea. A careful differential diagnosis is therefore necessary.

For example, candidiasis and trichomoniasis can both cause itching, discomfort in the vaginal area and unusual discharge. The difference is that with candidiasis the discharge is cottage cheese-like and white, whereas with trichomoniasis it is yellowish or greenish, frothy and accompanied by a characteristic unpleasant odour. In addition, candidiasis is a fungal infection that more often causes severe irritation but does not usually alter vaginal pH as markedly as trichomoniasis does.

Another symptom that can cause confusion is the unpleasant odour of the discharge. This can be caused by both trichomoniasis and bacterial vaginosis. Distinguishing features include the colour of the discharge and the nature of the odour. With vaginosis, the discharge is grey or yellowish-white, and the characteristic odour is most noticeable after intercourse.

Urethral or vaginal discharge along with discomfort on urination are signs common to both gonorrhoea and trichomoniasis. The difference is that with gonorrhoea the discharge is less frothy, with a more watery consistency and a more yellowish colour. Gonorrhoea is also more frequently associated with severe lower abdominal pain.

Differential diagnosis and specific tests are necessary to reach the correct diagnosis – which is crucial for choosing the appropriate treatment, as this varies depending on the pathogen involved.

Equally important is testing and treating both sexual partners, in order to prevent reinfection and further spread of the infection.

Treatment of trichomoniasis

It is highly unlikely that the condition will clear up without treatment. The infection can, however, be treated effectively with antibiotics prescribed by a doctor. It is just as important to follow medical advice in order to support recovery and avoid reinfection.

Recommended medicines for trichomoniasis

The standard treatment for trichomoniasis involves taking antibiotics such as metronidazole. The doctor will prescribe the dosage and duration of treatment according to the severity of the symptoms and the patient's state of health.

The treatment regimen, once established, must be completed in full, even if the symptoms disappear quickly.

Drinking alcohol is contraindicated during antibiotic treatment, as it can trigger side effects. These medicines are also used only with caution during pregnancy, particularly in the first trimester – so do be sure to discuss this with your doctor if you are pregnant.

Rules for treating trichomoniasis

A common problem with trichomoniasis is reinfection. According to statistics, around 20% of people who have been treated become infected again within the first 3 months after treatment.

For treatment to be effective and to prevent a new infection with Trichomonas vaginalis, a few rules should be observed:

• Treatment must be carried out by both sexual partners at the same time (or by all sexual partners where there are several).
• Sexual abstinence is recommended during treatment and for at least 7 days after it has finished.
• A follow-up medical check after 3–4 weeks is advisable to confirm that the infection has cleared.

Natural (supportive) treatment for trichomoniasis

Alongside the medication prescribed by your doctor, there are a few natural measures that can support recovery.

For instance, using vaginal probiotics can help restore the intimate flora after treatment. In addition, an anti-inflammatory diet and proper, gentle intimate care using products free from fragrances and harsh substances can support the recovery process.

Bear in mind: natural methods alone, without medication, cannot eliminate the infection. They are no substitute for the treatment prescribed by a specialist and are not an alternative to antibiotics – they serve merely to support recovery and bring faster relief from symptoms.

Complications and risks of untreated trichomoniasis

Without treatment, infection with Trichomonas vaginalis can persist and progress for a long time, which may lead to serious consequences for reproductive and general health.

Trichomoniasis increases the risk of contracting HIV and other sexually transmitted infections, as inflammation in the genital area makes it easier for other pathogens to enter. Furthermore, a persistent infection in women can encourage the development of pelvic inflammatory disease – a condition affecting the internal reproductive organs.

The infection can also cause complications in pregnancy, as trichomoniasis is associated with an increased risk of premature birth and low birth weight.

In the long term, an untreated infection can lead to secondary infertility and recurrent genital infections, owing to the disrupted balance of the vaginal flora.

Preventing and protecting yourself against trichomoniasis

Trichomoniasis can not only be treated effectively with the medicines prescribed by your doctor – infection and reinfection can also be prevented with a few simple hygiene and protection measures. It is recommended that you:

• Use condoms consistently during sexual intercourse.
• Have regular tests for sexually transmitted infections, at least once a year.
• Ensure both partners are treated at the same time in the event of an infection.
• Avoid sharing sex toys and intimate items.
• Seek sound sex education and maintain open communication between partners about sexual health.

Frequently asked questions about trichomoniasis (FAQ)

If you're looking for quick answers about trichomoniasis, we've gathered the most common questions in this section – with clear answers to help you better understand what you need to know about treating trichomoniasis, detecting the infection and preventive measures.

Can trichomoniasis come back after treatment?

Yes, reinfection is possible if your sexual partner is not treated at the same time, or if there is further unprotected intercourse with an infected person.

Can trichomoniasis clear up on its own without treatment?

In most cases the infection does not clear up by itself. Without treatment, the parasite can survive in the urogenital tract for months or even years and lead to complications.

What happens if I don't treat trichomoniasis?

An untreated infection can increase the risk of contracting other sexually transmitted diseases such as HIV, encourage the development of pelvic inflammatory disease and lead to complications such as secondary infertility and recurrent genital infections.

Can I get pregnant if I have trichomoniasis?

Yes, pregnancy is possible, although the infection during pregnancy is associated with an increased risk of premature birth and low birth weight.

Is trichomoniasis a serious condition?

Trichomoniasis is an infection that can be prevented and treated effectively with antibiotics. Without treatment, however, a long-standing infection can lead to serious complications for intimate and reproductive health.

How long does treatment for trichomoniasis last?

The dosage and duration of treatment for trichomoniasis are determined by your doctor – according to the severity of the symptoms and the patient's state of health. It is important that the treatment regimen, once established, is completed in full, even if the symptoms improve sooner, in order to prevent reinfection.

How is trichomoniasis diagnosed?

The diagnosis is made by a gynaecologist or urologist through a clinical examination and laboratory tests on genital secretions.

Is a follow-up test needed after treatment?

Yes, a follow-up test 3–4 weeks after treatment is recommended to confirm that the infection has cleared.

How can I prevent trichomoniasis?

Using a condom during every act of intercourse, for the entire duration of contact, having annual tests and treating both partners are the most effective methods of prevention. You should also avoid sharing sex toys to reduce the risk of infection.

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