Trichomoniasis

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Maybe you haven't heard of this infection. It is the stepchild of sexually transmitted disease—one that is hard enough to pronounce, let alone find information about why it is important to avoid.

Ironically, trichomoniasis (trick-o-mon-i-a-sis or "trich") is the most common curable sexually transmitted disease (STD) in the United States. In recent years, however, diagnosing and treating this disease has become a greater priority as new research has shown that it is not quite as harmless as was once thought.

Each year, an estimated 7.4 million cases of trichomoniasis occur in the United States. Trichomoniasis usually causes no symptoms in men; when it does cause symptoms, some men experience irritation inside the penis, mild discharge, or slight burning after urination or ejaculation. Some women with the infection experience a frothy, yellow-green vaginal discharge with a strong odor, discomfort during intercourse and urination, or itching in the genital area. In rare cases, pain in the lower abdomen can also occur. Women infected with trichomoniasis appear to be more at risk of acquiring HIV (human immunodeficiency virus) and other STDs.

If trichomoniasis is so common and causes significant risks to women's health, one would expect to find more interest in its prevention. There are several reasons that this STD has been ignored. First, its symptoms—primarily discharge and irritation of the vagina and urethra—have been seen as troubling but not taken as serious as other STDs. And second, the most common treatments, the drugs metronidazole and tinidazole are highly effective and have not been threatened by the development of resistant organisms that have caused problems in treating other STDs.

The organisms that causes trichomoniasis are protozoan (the simplest, single-cell organism in the animal kingdom) called trichomonads, the most common being Trichomonas vaginalis. This parasite resides primarily in the genitourinary tract, where it finds the warmth and moisture needed to grow and multiply.

Trichomoniasis is the least common of three types of vaginitis. The other two are bacterial vaginosis (BV), which is an overgrowth of normal bacteria found in the vagina, and vulvovaginal candidiasis, more commonly known as yeast infection. The overall prevalence of trichomoniasis makes up only about five percent of vaginal infections.

As with BV, recent research has clearly shown that trichomoniasis can be associated with preterm delivery complications. And pregnant women with trichomoniasis may have babies born with a low birth weight (less than 5.5 pounds).

Research also links trichomoniasis with an increased risk of HIV transmission (HIV is the virus that leads to AIDS). Although more study is needed, experts estimate that women infected with this STD are at a higher risk of acquiring HIV than uninfected women. A 2002 study of 696 African women attending an STD clinic found an association between both trichomoniasis and PID in women with HIV. The reason for this increased risk is that vaginitis increases a response from the immune system, producing more of the cells that HIV targets for infection.

Trichomoniasis is transmitted primarily through sexual intercourse. It is most common in people who are at their peak of sexual activity. Infection with other STDs and having multiple sex partners are primary factors that put women at higher risk. In some cases, trichomoniasis may be transmitted by a pregnant woman to her baby during childbirth.

In the United States, about three percent of women are infected. Among women infected with other STDs, such as gonorrhea, the rate of trichomoniasis is higher. For reasons not entirely clear, African American women have higher rates (more than double in some studies) than Caucasians and Hispanic and Latina women.